Charat Thongprayoon1,2, Wisit Cheungpasitporn3,4, Michael A Mao1, Ankit Sakhuja5, Stephen B Erickson1. 1. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. 2. Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA. 3. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. wcheungpasitporn@gmail.com. 4. Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA. wcheungpasitporn@gmail.com. 5. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Abstract
BACKGROUND: Evidence on the association between elevated admission serum phosphate and risk of in-hospital acute kidney injury (AKI) is limited. The aim of this study was to assess the risk of AKI in hospitalized patients stratified by admission serum phosphate level. METHODS: This is a single-center retrospective study conducted at a tertiary referral hospital. All hospitalized adult patients who had admission phosphate measurement available between January and December 2013 were enrolled. Admission phosphate was categorized into 6 groups (< 2.4, 2.4-2.9, 2.9-3.4, 3.4-3.9, 3.9-4.4, and ≥ 4.4 mg/dl). The primary outcome was in-hospital AKI occurring after hospital admission. Logistic regression analysis was performed to obtain the odds ratio of AKI for various admission phosphate strata using the phosphate 2.4-2.9 mg/dl level (lowest incidence of AKI) as the reference group. RESULTS: After excluding patients with end-stage renal disease (ESRD), without serum phosphate measurement, and those with AKI at time of admission, a total of 5036 patients were studied. Phosphate levels of < 2.4 and ≥ 4.4 mg/dl were found in 458 (9.1%) and 585 (11.6%) patients, respectively. In-hospital AKI occurred in 595 (11.8%) patients. The incidence of AKI among patients with admission phosphate < 2.4, 2.4-2.9, 2.9-3.4, 3.4-3.9, 3.9-4.4, and ≥ 4.4 mg/dl was 10.5, 9.5, 11.8, 10.0, 12.8, and 17.9%, respectively. After adjusting for potential confounders, admission serum phosphate > 4.4 mg/dl was associated with an increased risk of developing AKI with an odds ratio of 1.72 (95% confidence interval 1.20-2.47), whereas admission serum phosphate levels < 4.4 mg/dl were not associated with development of AKI during hospitalization. CONCLUSION: Elevated admission phosphate is associated with an increased risk for in-hospital AKI.
BACKGROUND: Evidence on the association between elevated admission serum phosphate and risk of in-hospital acute kidney injury (AKI) is limited. The aim of this study was to assess the risk of AKI in hospitalized patients stratified by admission serum phosphate level. METHODS: This is a single-center retrospective study conducted at a tertiary referral hospital. All hospitalized adult patients who had admission phosphate measurement available between January and December 2013 were enrolled. Admission phosphate was categorized into 6 groups (< 2.4, 2.4-2.9, 2.9-3.4, 3.4-3.9, 3.9-4.4, and ≥ 4.4 mg/dl). The primary outcome was in-hospital AKI occurring after hospital admission. Logistic regression analysis was performed to obtain the odds ratio of AKI for various admission phosphate strata using the phosphate 2.4-2.9 mg/dl level (lowest incidence of AKI) as the reference group. RESULTS: After excluding patients with end-stage renal disease (ESRD), without serum phosphate measurement, and those with AKI at time of admission, a total of 5036 patients were studied. Phosphate levels of < 2.4 and ≥ 4.4 mg/dl were found in 458 (9.1%) and 585 (11.6%) patients, respectively. In-hospital AKI occurred in 595 (11.8%) patients. The incidence of AKI among patients with admission phosphate < 2.4, 2.4-2.9, 2.9-3.4, 3.4-3.9, 3.9-4.4, and ≥ 4.4 mg/dl was 10.5, 9.5, 11.8, 10.0, 12.8, and 17.9%, respectively. After adjusting for potential confounders, admission serum phosphate > 4.4 mg/dl was associated with an increased risk of developing AKI with an odds ratio of 1.72 (95% confidence interval 1.20-2.47), whereas admission serum phosphate levels < 4.4 mg/dl were not associated with development of AKI during hospitalization. CONCLUSION: Elevated admission phosphate is associated with an increased risk for in-hospital AKI.
Authors: Ron Wald; Marc B Goldstein; Jeffrey Perl; Mercedeh Kiaii; Darren Yuen; Rachel M Wald; Ziv Harel; Jordan J Weinstein; Baruch Jakubovic; Howard Leong-Poi; Anish Kirpalani; Jonathon Leipsic; Niki Dacouris; Myles Wolf; Andrew T Yan Journal: Can J Cardiol Date: 2015-07-09 Impact factor: 5.223
Authors: Suetonia C Palmer; Sharon Gardner; Marcello Tonelli; Dimitris Mavridis; David W Johnson; Jonathan C Craig; Richard French; Marinella Ruospo; Giovanni F M Strippoli Journal: Am J Kidney Dis Date: 2016-07-22 Impact factor: 8.860
Authors: Wisit Cheungpasitporn; Charat Thongprayoon; Panupong Hansrivijit; Juan Medaura; Api Chewcharat; Tarun Bathini; Michael A Mao; Stephen B Erickson Journal: Adv Biomed Res Date: 2020-04-22
Authors: Hongran Moon; Ho Jun Chin; Ki Young Na; Kwon Wook Joo; Yon Su Kim; Sejoong Kim; Seung Seok Han Journal: BMC Nephrol Date: 2019-09-18 Impact factor: 2.388
Authors: Charat Thongprayoon; Pradeep Vaitla; Voravech Nissaisorakarn; Michael A Mao; Jose L Zabala Genovez; Andrea G Kattah; Pattharawin Pattharanitima; Saraschandra Vallabhajosyula; Mira T Keddis; Fawad Qureshi; John J Dillon; Vesna D Garovic; Kianoush B Kashani; Wisit Cheungpasitporn Journal: Med Sci (Basel) Date: 2021-09-24