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Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy

Charat Thongprayoon1, Yeshwanter Radhakrishnan1, Wisit Cheungpasitporn1

  • 1Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

Canadian Journal of Kidney Health and Disease
|August 4, 2022
PubMed

Insights

Serum phosphate levels impact mortality in critically ill patients on continuous renal replacement therapy (CRRT). Both low and high phosphate before CRRT, and high phosphate during CRRT, were linked to increased 90-day mortality.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Clinical Chemistry

Background:

  • Limited evidence exists on the association between serum phosphate and mortality in patients undergoing continuous renal replacement therapy (CRRT).
  • Understanding this relationship is crucial for managing critically ill patients with acute kidney injury (AKI).

Purpose of the Study:

  • To investigate the association between pre- and during-CRRT serum phosphate levels and 90-day mortality in critically ill AKI patients.
  • To determine if hypophosphatemia or hyperphosphatemia predicts mortality in this patient population.

Main Methods:

  • A retrospective cohort study was conducted involving 1108 AKI patients receiving CRRT.
  • Serum phosphate levels were categorized as hypophosphatemia (≤2.4 mg/dL), normophosphatemia (2.5-4.5 mg/dL), and hyperphosphatemia (≥4.6 mg/dL) before and during CRRT.
  • Multivariable logistic regression analysis was used to assess the association with 90-day mortality.

Main Results:

  • 55% of patients died within 90 days of CRRT initiation.
  • Before CRRT, both hypophosphatemia (OR 2.22) and hyperphosphatemia (OR 1.62) were significantly associated with higher 90-day mortality.
  • During CRRT, hyperphosphatemia remained significantly associated with increased 90-day mortality (OR 2.22).

Conclusions:

  • Both hypophosphatemia and hyperphosphatemia before CRRT initiation are associated with increased mortality.
  • Hyperphosphatemia during CRRT is also a significant predictor of higher mortality.
  • These findings highlight the importance of monitoring and managing serum phosphate levels in CRRT patients.
Abstract

Keywords:
continuous renal replacement therapyelectrolyteshyperphosphatemiahypophosphatemiamortalityphosphate

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