The influence of hypophosphatemia on outcomes of low- and high-intensity continuous renal replacement therapy in critically ill patients with acute kidney injury

Kim, Soo Young; Kim, Ye Na; Shin, Ho Sik; Jung, Yeonsoon; Rim, Hark

doi:10.23876/j.krcp.2017.36.3.240

Cited by 14 publications

(14 citation statements)

References 26 publications

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“…Hypophosphatemia is a frequent complication among patients undergoing CRRT. The high occurrence of hypophosphatemia is due to the ongoing intercompartmental mass transfer associated with CRRT because of its often longer duration than other dialysis modalities [3,6,7]. The incidence of hypophosphatemia in our study was similar to the reported range of 54-65% found in the RENAL study [10].…”

Section: Discussion/conclusionsupporting

confidence: 86%

“…Hypophosphatemia has been shown to occur in up to 80% of patients receiving CRRT [5]. Phosphate is vital to normal human physiology, serving as a structural component of cell membranes (phospholipids), an essential energy source (adenosine triphosphate), and a second messenger (adenosine monophosphate) [6,7]. Hypophosphatemia may result in diaphragmatic weakness and can precipitate cardiac arrhythmias, seizures, rhabdomyolysis, and hemolysis [6].…”

Section: Introductionmentioning

confidence: 99%

“…Hypophosphatemia may result in diaphragmatic weakness and can precipitate cardiac arrhythmias, seizures, rhabdomyolysis, and hemolysis [6]. Specifically in patients undergoing CRRT, hypophosphatemia has been associated with prolonged mechanical ventilation and increased need for tracheostomy placement [7,8]. However, many studies have failed to demonstrate a significant association between hypophosphatemia and increased mortality [9].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Hypophosphatemia and Outcomes during Continuous Renal Replacement Therapy

et al. 2020

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Introduction: Hypophosphatemia occurs in up to 80% of patients undergoing continuous renal replacement therapy (CRRT) and has been associated with poor outcomes. Whether preemptive phosphate supplementation is warranted in select patients has not been adequately explored. This single-center, retrospective cohort study evaluates predictors of hypophosphatemia and characterizes treatment approaches in adult patients undergoing at least 12 h of CRRT. Methods: Patients were divided into 2 groups based on the presence or absence of hypophosphatemia as defined by serum phosphorus < 2.5 mg/dL. Select laboratory values at baseline and during CRRT, medications and nutritional sources affecting phosphorus, and CRRT parameters were compared. Patient outcomes including resolution of acute kidney injury (AKI), freedom from renal replacement therapy at hospital discharge, duration of intensive care unit (ICU) and hospital stay, duration of mechanical ventilation, and ICU mortality were evaluated. Results: Seventy-two patients were included. The group was 43% female and 51% African American. CRRT was ordered for AKI in 83% and for endstage renal disease in 15%. Hypophosphatemia occurred in 45 patients (63%). Mean time to development of hypophosphatemia was 34 ± 22 h. Patients who developed hypophosphatemia received a longer duration of CRRT (p = 0.001), were more likely to have a diet ordered (p = 0.005), less likely to have received calcium infusions (p = 0.045), and had lower phosphorus (p = 0.017) and potassium levels (p = 0.038) and higher calcium levels at baseline (p = 0.048). Development of hypophosphatemia was associated with an increased duration of ICU stay (p = 0.014) but not with the other patient outcomes evaluated. Twenty-seven of the 45 patients (60%) who developed hypophosphatemia received phosphorus supplementation with near equal use of intravenous, oral, and combination routes. Only 17 patients (38%) achieved resolution of hypophosphatemia while on CRRT. Conclusion: Hypophosphatemia is common, difficult to cor

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Section: Discussion/conclusionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of Hypophosphatemia and Outcomes during Continuous Renal Replacement Therapy

et al. 2020

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“…Many clinicians still rely on the expert recommendations released by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. While initiating CRRT early or preemptively may be theoretically beneficial due to the avoidance of life-threatening hyperkalemia, pulmonary edema, and more rapid correction of electrolyte and acid-base abnormalities, it also carries an increased risk of catheter related bacteremia, loss of watersoluble vitamins and micronutrients, and antibiotic underdosing, collectively called dialytrauma [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Impact of Early Initiation of Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

Yang

Lim

Ahn

et al. 2021

J Health Care and Research

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Background: Although continuous renal replacement therapy (CRRT) has become the most commonly used modality for critically ill patients with acute kidney injury (AKI), the optimal timing of initiation remains controversial. CRRT is usually initiated when conventional indications of AKI arise; however, preemptive therapy may be beneficial. We evaluated the prevalence of preemptive and conventional CRRT initiation in critically ill patients and compared the associated 90-day mortality and renal recovery. Methods: This retrospective study was performed in 2 tertiary centers between 2014 and 2017. Patients were divided into preemptive and conventional groups according to CRRT indications at the time of initiation. The primary clinical outcomes were 90-day mortality and renal recovery. Renal recovery was defined as a creatinine clearance of ≥15 mL/min and no need for renal replacement therapy for an additional 90 days. Results: Patients with preemptive initiation showed higher diastolic blood pressure, higher bicarbonate level, lower blood urea nitrogen, and lower initial 6-h urine output at the time of initiation. More required simultaneous extracorporeal membrane oxygenation. This group showed a significantly lower 90-day mortality and higher renal recovery rate. In multivariate analysis, late initiation of CRRT remained an independent risk factor for increased 90-day mortality and lack of renal recovery in survivors. Conclusion: Our study demonstrated that early preemptive CRRT initiation is associated with significantly lower 90-day mortality and higher renal recovery. Additional large-scale randomized controlled trials are needed to determine the optimal timing of therapy.

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“…Acute kidney injury (AKI) is a serious complication in critically ill patients treated in the intensive care unit (ICU) because of high mortality and economic conditions. [1–3] Sepsis is the leading cause of AKI in the ICU, and approximately 45% to 70% of all AKI is associated with sepsis. [4–6] Compared with patients with AKI without septic shock, patients with AKI and septic shock may have a different response to renal replacement therapy (RRT).…”

Section: Introductionmentioning

confidence: 99%

Early initiation renal replacement therapy for fluid management to reduce central venous pressure is more conducive to renal function recovery in patients with acute kidney injury

Xing

Liu

Wang

et al. 2019

Chinese Medical Journal

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Background: Acute kidney injury (AKI) is a serious complication in critically ill patients with septic shock treated in the intensive care unit. Renal replacement therapy (RRT) is a treatment for severe AKI; however, the time of initiation of RRT and factors that affect the recovery of kidney function remains unclear. This study was to explore whether early initiation of RRT treatment for fluid management to reduce central venous pressure (CVP) can help to improve patients’ kidney function recovery. Methods: A retrospective analysis of septic patients who had received RRT treatment was conducted. Patients received RRT either within 12 h after they met the diagnostic criteria of renal failure (early initiation) or after a delay of 48 h if renal recovery had not occurred (delayed initiation). Parameters such as patients’ renal function recovery at discharge, fluid balance, and levels of CVP were assessed. Results: A total of 141 patients were eligible for enrolment: 40.4% of the patients were in the early initiation group (57 of 141 patients), and 59.6% were in the delayed initiation group (84 of 141 patients). There were no significant differences in the characteristics at baseline between the two groups, and there were no differences in 28-day mortality between the two groups (χ 2 = 2.142, P = 0.143); however, there was a significant difference in the recovery rate of renal function between the two groups at discharge (χ 2 = 4.730, P < 0.001). More importantly, early initiation of RRT treatment and dehydration to reduce CVP are more conducive to the recovery of renal function in patients with AKI. Conclusion: Compared with those who received delayed initiation RRT, patients who received early-initiation RRT for dehydration to reduce CVP have enhanced kidney function recovery.

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The influence of hypophosphatemia on outcomes of low- and high-intensity continuous renal replacement therapy in critically ill patients with acute kidney injury

Cited by 14 publications

References 26 publications

Predictors of Hypophosphatemia and Outcomes during Continuous Renal Replacement Therapy

Predictors of Hypophosphatemia and Outcomes during Continuous Renal Replacement Therapy

Impact of Early Initiation of Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

Early initiation renal replacement therapy for fluid management to reduce central venous pressure is more conducive to renal function recovery in patients with acute kidney injury

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