Rinaldo Bellomo1, Alan Cass2, Louise Cole3, Simon Finfer4, Martin Gallagher5, Inbyung Kim6, Joanne Lee5, Serigne Lo5, Colin McArthur7, Shay McGuinness, Shay McGuiness7, Robyn Norton5, John Myburgh5, Carlos Scheinkestel8. 1. Australian and New Zealand Intensive Care Research Centre, Melbourne, VIC, Australia. 2. Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. 3. Intensive Care Unit, Nepean Hospital, Sydney, NSW, Australia. 4. Intensive Care Department, Royal North Shore Hospital, Sydney, NSW, Australia. 5. The George Institute for Global Health, Sydney, NSW, Australia. 6. Intensive Care Unit, Austin Hospital, Melbourne, VIC, Australia. 7. Auckland City Hospital, Auckland, New Zealand. 8. Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia.
Abstract
AIM: To identify risk factors for development of hypophosphataemia in patients treated with two different intensities ofcontinuous 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.
RCT Entities:
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.
Authors: Sun Ae Han; Ha Yeol Park; Hyun Woo Kim; Jong In Choi; Da Yeong Kang; Hyun Lee Kim; Jong Hoon Chung; Byung Chul Shin Journal: Electrolyte Blood Press Date: 2019-12-31