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The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy

Bellomo, Rinaldo, Cass, Alan, Cole, Louise, Finfer, Simon, Gallagher, Martin, Kim, Inbyung, Lee, Joanne, Lo, Serigne, McArthur, Colin, McGuiness, Shay, Norton, Robyn, Myburgh, John and Scheinkestel, Carlos (2014). The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy. Critical Care and Resuscitation,16(1):34-41.

Document type: Journal Article
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IRMA ID 11035xPUB73
Title The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy
Author Bellomo, Rinaldo
Cass, Alan
Cole, Louise
Finfer, Simon
Gallagher, Martin
Kim, Inbyung
Lee, Joanne
Lo, Serigne
McArthur, Colin
McGuiness, Shay
Norton, Robyn
Myburgh, John
Scheinkestel, Carlos
Journal Name Critical Care and Resuscitation
Publication Date 2014
Volume Number 16
Issue Number 1
ISSN 1441-2772   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84908257707
Start Page 34
End Page 41
Total Pages 8
Place of Publication Australia
Publisher Australasian Medical Publishing Company Pty. Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Aim: 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.

Materials and methods: 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. Results: 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.

Conclusions: 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.
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URL http://search.informit.com.au/documentSummary;dn=164837080355903;res=IELHEA
 
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Created: Wed, 19 Aug 2015, 12:09:22 CST