Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy.
Electrolyte and mineral disturbances remain a major concern in patients undergoing continuous renal replacement therapy (CRRT); however, it is not clear whether those imbalances are associated with adverse outcomes in patients with septic acute kidney injury (AKI) undergoing CRRT. We conducted a post-hoc analysis of data from a prospective randomized controlled trial. A total of 210 patients with a mean age of 62.2 years (136 [64.8%] males) in 2 hospitals were enrolled. Levels of sodium, potassium, calcium, and phosphate measured before (0 hour) and 24 hours after CRRT initiation. Before starting CRRT, at least 1 deficiency and excess in electrolytes or minerals were observed in 126 (60.0%) and 188 (67.6%) patients, respectively. The excess in these parameters was greatly improved, whereas hypokalemia and hypophosphatemia became more prevalent at 24 hours after CRRT. However, 1 and 2 or more deficiencies in those parameters at the 2 time points were not associated with mortality. However, during 28 days, 89 (71.2%) deaths occurred in patients with phosphate levels at 0 hour of ≥4.5 mg/dL as compared with 49 (57.6%) in patients with phosphate levels <4.5 mg/dL. The 90-day mortality was also significantly higher in patients with hyperphosphatemia. Similarly, in 184 patients who survived at 24 hours after CRRT, hyperphosphatemia conferred a 2.2-fold and 2.6-fold increased risk of 28- and 90-day mortality, respectively. The results remained unaltered when the serum phosphate level was analyzed as a continuous variable. Electrolyte and mineral disturbances are common, and hyperphosphatemia may predict poor prognosis in septic AKI patients undergoing CRRT.
Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea. Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Su-Young
SY
Jung
Hyunwook
H
Kim
Seohyun
S
Park
Jong Hyun
JH
Jhee
Hae-Ryong
HR
Yun
Hyoungnae
H
Kim
Youn Kyung
YK
Kee
Chang-Yun
CY
Yoon
Hyung Jung
HJ
Oh
Tae Ik
TI
Chang
Jung Tak
JT
Park
Tae-Hyun
TH
Yoo
Shin-Wook
SW
Kang
Hajeong
H
Lee
Dong Ki
DK
Kim
Seung Hyeok
SH
Han
D058186:Acute Kidney Injury / Q000097:blood* / Q000150:complications / Q000401:mortality; D000368:Aged; D004573:Electrolytes / Q000097:blood*; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000209:etiology / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D018805:Sepsis / Q000097:blood / Q000150:complications; D014131:Trace Elements / Q000097:blood
D004573:Electrolytes; D014131:Trace Elements