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

Rinaldo Bellomo, Alan Cass, Louise Cole, Simon Finfer, Martin Gallagher, Inbyung Kim, Joanne Lee, Serigne Lo, Colin McArthur, Shay McGuiness, Robyn Norton, John Myburgh, Carlos Scheinkestel

    Research output: Contribution to journalArticleResearchpeer-review

    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.
    Original languageEnglish
    Pages (from-to)34-41
    Number of pages8
    JournalCritical Care and Resuscitation
    Volume16
    Issue number1
    Publication statusPublished - 2014

    Fingerprint

    Renal Replacement Therapy
    Incidence
    Phosphates
    APACHE
    Hypokalemia
    Randomized Controlled Trials
    Logistic Models
    Odds Ratio
    Regression Analysis
    Mortality

    Cite this

    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. / The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy. In: Critical Care and Resuscitation. 2014 ; Vol. 16, No. 1. pp. 34-41.
    @article{0d087f1a3f184d46b4ccd22674335f59,
    title = "The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy",
    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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    author = "Rinaldo Bellomo and Alan Cass and Louise Cole and Simon Finfer and Martin Gallagher and Inbyung Kim and Joanne Lee and Serigne Lo and Colin McArthur and Shay McGuiness and Robyn Norton and John Myburgh and Carlos Scheinkestel",
    year = "2014",
    language = "English",
    volume = "16",
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    Bellomo, R, Cass, A, Cole, L, Finfer, S, Gallagher, M, Kim, I, Lee, J, Lo, S, McArthur, C, McGuiness, S, Norton, R, Myburgh, J & Scheinkestel, C 2014, 'The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy', Critical Care and Resuscitation, vol. 16, no. 1, pp. 34-41.

    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; Scheinkestel, Carlos.

    In: Critical Care and Resuscitation, Vol. 16, No. 1, 2014, p. 34-41.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy

    AU - Bellomo, Rinaldo

    AU - Cass, Alan

    AU - Cole, Louise

    AU - Finfer, Simon

    AU - Gallagher, Martin

    AU - Kim, Inbyung

    AU - Lee, Joanne

    AU - Lo, Serigne

    AU - McArthur, Colin

    AU - McGuiness, Shay

    AU - Norton, Robyn

    AU - Myburgh, John

    AU - Scheinkestel, Carlos

    PY - 2014

    Y1 - 2014

    N2 - 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.

    AB - 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.

    KW - phosphate

    KW - adult

    KW - article

    KW - Australia

    KW - blood

    KW - controlled clinical trial

    KW - controlled study

    KW - critical illness

    KW - female

    KW - follow up

    KW - human

    KW - hypophosphatemia

    KW - incidence

    KW - male

    KW - methodology

    KW - multicenter study

    KW - New Zealand

    KW - prognosis

    KW - randomized controlled trial

    KW - renal replacement therapy

    KW - retrospective study

    KW - survival rate

    KW - Adult

    KW - Critical Illness

    KW - Female

    KW - Follow-Up Studies

    KW - Humans

    KW - Hypophosphatemia

    KW - Incidence

    KW - Male

    KW - Phosphates

    KW - Prognosis

    KW - Renal Replacement Therapy

    KW - Retrospective Studies

    KW - Survival Rate

    M3 - Article

    VL - 16

    SP - 34

    EP - 41

    JO - Critical Care and Resuscitation

    JF - Critical Care and Resuscitation

    SN - 1441-2772

    IS - 1

    ER -