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      Predictors of Hypophosphatemia and Outcomes during Continuous Renal Replacement Therapy

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          Abstract

          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 end-stage 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 correct, and contributes to longer ICU stays in patients requiring CRRT. A preemptive approach to address hypophosphatemia including aggressive supplementation strategies to correct phosphorus is warranted in patients requiring CRRT.

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          Author and article information

          Journal
          BPU
          Blood Purif
          10.1159/issn.0253-5068
          Blood Purification
          S. Karger AG
          0253-5068
          1421-9735
          2020
          November 2020
          22 April 2020
          : 49
          : 6
          : 700-707
          Affiliations
          aDepartment of Pharmacy, Methodist Le Bonheur Healthcare University Hospital, Memphis, Tennessee, USA
          bDepartments of Medicine (Nephrology) and Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
          cDepartments of Clinical Pharmacy and Translational Science and Medicine (Nephrology), University of Tennessee Health Science Center, Memphis, Tennessee, USA
          Author notes
          *Joanna Q. Hudson, Departments of Clinical Pharmacy and Translational Science and Medicine (Nephrology)University of Tennessee Health Science Center, 881 Madison, Room 334, Memphis, TN 38163 (USA), E-Mail jhudson@uthsc.edu
          Article
          507421 Blood Purif 2020;49:700–707
          10.1159/000507421
          32320987
          © 2020 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Tables: 4, Pages: 8
          Categories
          Research Article

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