Related Experiment Video
Updated: Jul 15, 2026
Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Hypophosphatemia-factors associated with its development and 90-day mortality effect: a prospective observational
Liran Statlender1,2, Tzippy Shochat3, Limor Rozilyo4
1Department of General Intensive Care, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
Insights
Critically ill patients with hypophosphatemia showed altered phosphate renal handling, specifically in creatinine clearance and tubular reabsorption. Restrictive energy delivery was not linked to hypophosphatemia.
Area of Science:
- Critical Care Medicine
- Nephrology
- Intensive Care Unit (ICU) Management
Background:
- Hypophosphatemia is common in critically ill patients, but data on energy delivery and renal phosphate handling are limited.
- Understanding factors influencing hypophosphatemia is crucial for optimizing patient care in the ICU.
Purpose of the Study:
- To investigate the relationship between restrictive energy delivery, phosphate renal handling, and the development of hypophosphatemia in critically ill patients.
- To identify predictors of hypophosphatemia and its association with 90-day mortality.
Main Methods:
- Observational study of 181 ventilated ICU patients with stays >48 hours.
- Daily monitoring of serum phosphate, energy/phosphate delivery, fluid balance, and 6-hour urine collections for creatinine and phosphate.
- Calculation of creatinine clearance (CrCl6hr), tubular reabsorption of phosphate (TRP), and TmP/GFR; regression analyses for hypophosphatemia and mortality.
Main Results:
- 60.22% of patients developed hypophosphatemia.
- No association found between energy delivery and hypophosphatemia.
- Multivariate analysis linked hypophosphatemia to log of CrCl6hr and TmP/GFR, not energy delivery.
Conclusions:
- Phosphate renal handling, measured by CrCl6hr and TmP/GFR, is associated with hypophosphatemia in critically ill patients.
- Energy delivery was not associated with hypophosphatemia.
- While hypophosphatemia showed univariate association with mortality, it was not significant in multivariate analysis; age and APACHE2 score were mortality predictors.
Background:
Several factors are associated with hypophosphatemia. There is a paucity of data regarding the effects of restrictive energy delivery and phosphate renal handling with hypophosphatemia in the critically ill patient.
Methods:
This is a single-center observational study. Patients were included if they were admitted ventilated and their ICU stay was at least 48 h. Baseline characteristics were recorded upon admission; other variables were collected daily during the first five admission days: SOFA1 score, serum phosphate, energy delivery, phosphate delivery and fluid balance. A 6-h urine collection for phosphate and creatinine was performed daily. Creatinine clearance (CrCl6hr), tubular reabsorption of phosphate (TRP), and tubular maximal reabsorption rate of phosphate adjusted to the glomerular filtration rate (TmP/GFR) were calculated. Mortality follow up time was 90 days. A comparison was made between patients who developed hypophosphatemia (serum phosphate < 2.5 mg/dl), and those who did not. Univariate and multivariate regressions for hypophosphatemia and for 90-day mortality were performed.
Results:
One hundred eighty-one patients were included in the analysis. One hundred and nine (60.22%) developed hypophosphatemia. They were younger, had lower APACHE2 score, and were admitted more frequently due to trauma. No association of energy delivery with hypophosphatemia was found. In a multivariate analysis only log of CrCl6hr and TmP/GFR were associated with hypophosphatemia. Hypophosphatemia was associated with 90-d mortality in univariate analysis, but not in multivariate analysis.
Conclusion:
Creatinine clearance based on a 6-h urine collection and TmP/GFR were associated with hypophosphatemia, whereas energy delivery was not. Age and APACHE2 were associated with 90-d mortality, but hypophosphatemia was not.
Related Concept Videos
01:25Peritoneal Dialysis III: Nursing Management
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:24Chronic Kidney Disease II: Clinical Manifestations
01:29Factors Affecting Protein-Drug Binding: Patient-Related Factors
Age stands as a key determinant in protein-drug binding. Neonates, characterized by low albumin content, experience heightened concentrations of unbound drugs such as phenytoin and...
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:15Impact of Pharmacokinetic–Pharmacodynamic Models: Regulatory Decisions