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Title: The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy.
Austin Authors: Bellomo, Rinaldo ;Cass, Alan;Cole, Louise;Finfer, Simon;Gallagher, Martin;Kim, In Byung;Lee, Joanne;Lo, Serigne;McArthur, Colin J;McGuinness, Shay;McGuiness, Shay;Norton, Robyn;Myburgh, John;Scheinkestel, Carlos
Affiliation: Intensive Care Unit, Nepean Hospital, Sydney, NSW, Australia
Australian and New Zealand Intensive Care Research Centre, Melbourne, Victoria, Australia
Intensive Care Department, Royal North Shore Hospital, Sydney, NSW, Australia
Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia
Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
The George Institute for Global Health, Sydney, NSW, Australia
Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia
Auckland City Hospital, Auckland, New Zealand.
Issue Date: 1-Mar-2014
Publication information: Critical Care and Resuscitation; 16(1): 34-41
Abstract: To identify risk factors for development of hypophosphataemia in patients treated with two different intensities of continuous renal replacement therapy (CRRT) and to assess the independent association of hypophosphataemia with major clinical outcomes.We performed secondary analysis of data collected from 1441 patients during a large, multicentre randomised controlled trial of CRRT intensity. We allocated patients to two different intensities of CRRT (25mL/kg/hour vs 40 mL/kg/hour of effluent generation) and obtained daily measurement of serum phosphate levels.We obtained 14 115 phosphate measurements and identified 462 patients (32.1%) with hypophosphataemia, with peak incidence on Day 2 and Day 3. With lower intensity CRRT, there were 58 episodes of hypophosphataemia/1000 patient days, compared with 112 episodes/1000 patient days with higher intensity CRRT (P < 0.001). On multivariable logistic regression analysis, higher intensity CRRT, female sex, higher Acute Physiology and Chronic Health Evaluation score and hypokalaemia were independently associated with an increased odds ratio (OR) for hypophosphataemia. On multivariable models, hypophosphataemia was associated with better clinical outcomes, but when analysis was confined to patients alive at 96 hours, hypophosphataemia was not independently associated with clinical outcomes.Hypophosphataemia is common during CRRT and its incidence increases with greater CRRT intensity. Hypophosphataemia is not a robust independent predictor of mortality. Its greater incidence in the higher intensity CRRT arm of the Randomised Evaluation of Normal vs Augmented Level trial does not explain the lack of improved outcomes with such treatment.
Gov't Doc #: 24588434
Journal: Critical Care and Resuscitation
Type: Journal Article
Subjects: Adult
Critical Illness.therapy
Follow-Up Studies
New Zealand.epidemiology
Renal Replacement Therapy.methods
Retrospective Studies
Survival Rate.trends
Appears in Collections:Journal articles

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