Association of Phosphate Containing Solutions with Incident Hypophosphatemia in Critically Ill Patients Requiring Continuous Renal Replacement Therapy. 2022

Melissa L Thompson Bastin, and Paul M Adams, and Sethabhisha Nerusu, and Peter E Morris, and Kirby P Mayer, and Javier A Neyra
Department of Pharmacy Services, University of Kentucky Medical Center, Lexington, Kentucky, USA.

Hypophosphatemia in critically ill patients is a common electrolyte disturbance associated with a myriad of adverse effects. Critically ill patients requiring continuous renal replacement therapy (CRRT) are at high risk of hypophosphatemia and often require phosphate supplementation during therapy. The aim of this study was to evaluate the association of phosphate versus non-phosphate containing CRRT solutions with incident hypophosphatemia in critically ill patients requiring CRRT. This is a single-center, retrospective, cohort study at a tertiary academic medical center of 1,396 adult patients requiring CRRT during their intensive care unit stay comprising 7,529 (phosphate containing) and 4,821 (non-phosphate containing) cumulative days of CRRT. Multivariable logistic regression was used to model the primary outcome of hypophosphatemia during CRRT according to exposure to phosphate versus non-phosphate containing CRRT solutions. Incident hypophosphatemia during CRRT, serum phosphate <2.5 mg/dL or 0.81 mmol/L, was significantly higher in the non-phosphate versus phosphate containing solution group: 304/489 (62%) versus 175/853 (21%) (p < 0.001). Cumulative phosphate supplementation was also significantly higher in the non-phosphate versus phosphate containing solution group: 79 (IQR: 0-320) versus 0 (0-16) mmol (p < 0.001). Non-phosphate solutions were associated with an 8-fold increase in the incidence of hypophosphatemia (adjusted OR 8.05; 95% CI 5.77, 11.26; p < 0.001). The use of phosphate containing CRRT solutions was independently associated with reduced risk of incident hypophosphatemia and decreased phosphate supplementation during CRRT. Interventional studies to confirm these findings are needed.

UI MeSH Term Description Entries
D010710 Phosphates Inorganic salts of phosphoric acid. Inorganic Phosphate,Phosphates, Inorganic,Inorganic Phosphates,Orthophosphate,Phosphate,Phosphate, Inorganic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000079664 Continuous Renal Replacement Therapy Procedures with continuous blood purification (e.g., dialysis, filtration or perfusion) via vascular access designed to mimic kidney function in kidney diseases (e.g., ACUTE RENAL FAILURE and poisoning). CAVHD,CRRT Technique,CVVH Technique,CVVHD,CVVHDF,Continuous Arterio-Venous Ultrafiltration,Continuous RRT,Continuous Renal Replacement Procedure,Continuous Veno-Venous Hemodiafiltration,Continuous Veno-Venous Hemodialysis,Continuous Veno-Venous Hemofiltration,Continuous Venovenous Hemodiafiltration,Continuous Venovenous Hemodialysis,Continuous Venovenous Hemofiltration,Hemofiltration, Continuous Arteriovenous,SCUF Technique,Slow Continuous Ultrafiltration,Arterio-Venous Ultrafiltration, Continuous,Arteriovenous Hemofiltration, Continuous,CVVH Techniques,Continuous Arterio Venous Ultrafiltration,Continuous Arterio-Venous Ultrafiltrations,Continuous Arteriovenous Hemofiltration,Continuous Arteriovenous Hemofiltrations,Continuous RRTs,Continuous Veno Venous Hemodiafiltration,Continuous Veno Venous Hemodialysis,Continuous Veno Venous Hemofiltration,Continuous Veno-Venous Hemodiafiltrations,Continuous Veno-Venous Hemodialyses,Continuous Veno-Venous Hemofiltrations,Continuous Venovenous Hemodiafiltrations,Continuous Venovenous Hemodialyses,Continuous Venovenous Hemofiltrations,Hemodiafiltration, Continuous Veno-Venous,Hemodiafiltration, Continuous Venovenous,Hemodialysis, Continuous Veno-Venous,Hemodialysis, Continuous Venovenous,Hemofiltration, Continuous Veno-Venous,Hemofiltration, Continuous Venovenous,RRT, Continuous,SCUF Techniques,Slow Continuous Ultrafiltrations,Ultrafiltration, Continuous Arterio-Venous,Veno-Venous Hemodiafiltration, Continuous,Veno-Venous Hemodialyses, Continuous,Veno-Venous Hemodialysis, Continuous,Veno-Venous Hemofiltration, Continuous,Venovenous Hemodiafiltration, Continuous,Venovenous Hemodialysis, Continuous,Venovenous Hemofiltration, Continuous
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D015331 Cohort Studies Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. Birth Cohort Studies,Birth Cohort Study,Closed Cohort Studies,Cohort Analysis,Concurrent Studies,Historical Cohort Studies,Incidence Studies,Analysis, Cohort,Cohort Studies, Closed,Cohort Studies, Historical,Studies, Closed Cohort,Studies, Concurrent,Studies, Historical Cohort,Analyses, Cohort,Closed Cohort Study,Cohort Analyses,Cohort Studies, Birth,Cohort Study,Cohort Study, Birth,Cohort Study, Closed,Cohort Study, Historical,Concurrent Study,Historical Cohort Study,Incidence Study,Studies, Birth Cohort,Studies, Cohort,Studies, Incidence,Study, Birth Cohort,Study, Closed Cohort,Study, Cohort,Study, Concurrent,Study, Historical Cohort,Study, Incidence
D016638 Critical Illness A disease or state in which death is possible or imminent. Critically Ill,Critical Illnesses,Illness, Critical,Illnesses, Critical
D017582 Renal Replacement Therapy Procedures which temporarily or permanently remedy insufficient cleansing of body fluids by the kidneys. Kidney Replacement Therapy,Replacement Therapy, Kidney,Replacement Therapy, Renal,Therapy, Kidney Replacement,Therapy, Renal Replacement,Kidney Replacement Therapies,Renal Replacement Therapies,Replacement Therapies, Kidney,Replacement Therapies, Renal,Therapies, Kidney Replacement,Therapies, Renal Replacement
D017674 Hypophosphatemia A condition of an abnormally low level of PHOSPHATES in the blood. Hypophosphatemias
D058186 Acute Kidney Injury Abrupt reduction in kidney function. Acute kidney injury encompasses the entire spectrum of the syndrome including acute kidney failure; ACUTE KIDNEY TUBULAR NECROSIS; and other less severe conditions. Acute Kidney Failure,Acute Kidney Insufficiency,Acute Renal Failure,Acute Renal Injury,Acute Renal Insufficiency,Kidney Failure, Acute,Kidney Insufficiency, Acute,Renal Failure, Acute,Renal Insufficiency, Acute,Acute Kidney Failures,Acute Kidney Injuries,Acute Kidney Insufficiencies,Acute Renal Failures,Acute Renal Injuries,Acute Renal Insufficiencies,Kidney Failures, Acute,Kidney Injuries, Acute,Kidney Injury, Acute,Kidney Insufficiencies, Acute,Renal Failures, Acute,Renal Injuries, Acute,Renal Injury, Acute,Renal Insufficiencies, Acute

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