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

Rinaldo Bellomo, Alan Cass, Louise Cole, Simon R Finfer, Martin Patrick Gallagher, Inbyung Kim, Joanne Lee, Serigne Lo, Colin McArthur, Shay P McGuinness, Robyn Norton, John A Myburgh, Carlos D Scheinkestel

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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. 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. 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. 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

Cite this

Bellomo, Rinaldo ; Cass, Alan ; Cole, Louise ; Finfer, Simon R ; Gallagher, Martin Patrick ; Kim, Inbyung ; Lee, Joanne ; Lo, Serigne ; McArthur, Colin ; McGuinness, Shay P ; Norton, Robyn ; Myburgh, John A ; Scheinkestel, Carlos D. / 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.
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abstract = "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. 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. 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. 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.",
author = "Rinaldo Bellomo and Alan Cass and Louise Cole and Finfer, {Simon R} and Gallagher, {Martin Patrick} and Inbyung Kim and Joanne Lee and Serigne Lo and Colin McArthur and McGuinness, {Shay P} and Robyn Norton and Myburgh, {John A} and Scheinkestel, {Carlos D}",
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pages = "34 -- 41",
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The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy. / Bellomo, Rinaldo; Cass, Alan; Cole, Louise; Finfer, Simon R; Gallagher, Martin Patrick; Kim, Inbyung; Lee, Joanne; Lo, Serigne; McArthur, Colin; McGuinness, Shay P; Norton, Robyn; Myburgh, John A; Scheinkestel, Carlos D.

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

Research output: Contribution to journalArticleResearchpeer-review

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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 R

AU - Gallagher, Martin Patrick

AU - Kim, Inbyung

AU - Lee, Joanne

AU - Lo, Serigne

AU - McArthur, Colin

AU - McGuinness, Shay P

AU - Norton, Robyn

AU - Myburgh, John A

AU - Scheinkestel, Carlos D

PY - 2014

Y1 - 2014

N2 - 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. 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. 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. 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 - 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. 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. 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. 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.

UR - http://www.ncbi.nlm.nih.gov/pubmed/24588434

M3 - Article

VL - 16

SP - 34

EP - 41

JO - Critical Care and Resuscitation

JF - Critical Care and Resuscitation

SN - 1441-2772

IS - 1

ER -