title: Changes in serum phosphate and potassium and their effects on mortality in malnourished African HIV-infected adults starting antiretroviral therapy and given vitamins and minerals in lipid-based nutritional supplements: secondary analysis from the Nutritional Support for African Adults Starting Antiretroviral Therapy (NUSTART) trial.
abstract: Malnourished HIV-infected patients starting antiretroviral therapy (ART) are at high risk of early mortality, some of which may be attributed to altered electrolyte metabolism. We used data from a randomised controlled trial of electrolyte-enriched lipid-based nutritional supplements to assess the association of baseline and time-varying serum phosphate and K concentrations with mortality within the first 12 weeks after starting ART. Baseline phosphate results were available from 1764 patients and there were 9096 subsequent serum phosphate measurements, a median of 6 per patient. For serum K there were 1701 baseline and 8773 subsequent measures, a median of 6 per patient. Abnormally high or low serum phosphate was more common than high or low serum K. Controlling for other factors found to affect mortality in this cohort, low phosphate which had not changed from the previous time interval was associated with increased mortality; the same was not true for high phosphate or for high or low K. Both increases and decreases in serum electrolytes from the previous time interval were generally associated with increased mortality, particularly in the electrolyte-supplemented group. The results suggest that changes in serum electrolytes, largely irrespective of the starting point and the direction of change, were more strongly associated with mortality than were absolute electrolyte levels. Although K and phosphate are required for tissue deposition during recovery from malnutrition, further studies are needed to determine whether specific supplements exacerbate physiologically adverse shifts in electrolyte levels during nutritional rehabilitation of ill malnourished HIV patients.
authors.affiliation: 1London School of Hygiene & Tropical Medicine,London WC1E 7HT,UK.
authors.forename: Andrea Mary
authors.identifier: http://orcid.org/0000-0001-9967-5822
authors.initials: AM
authors.lastname: Rehman
authors.affiliation: 1London School of Hygiene & Tropical Medicine,London WC1E 7HT,UK.
authors.forename: Susannah Louise
authors.initials: SL
authors.lastname: Woodd
authors.affiliation: 2Vanderbilt University Medical Center,Nashville, TN 37232,USA.
authors.forename: Douglas Corbett
authors.identifier: http://orcid.org/0000-0003-3551-9710
authors.initials: DC
authors.lastname: Heimburger
authors.affiliation: 2Vanderbilt University Medical Center,Nashville, TN 37232,USA.
authors.forename: John Robert
authors.initials: JR
authors.lastname: Koethe
authors.affiliation: 3University of Copenhagen,1958 Copenhagen,Denmark.
authors.forename: Henrik
authors.identifier: http://orcid.org/0000-0002-2848-2940
authors.initials: H
authors.lastname: Friis
authors.affiliation: 4Mwanza Research Centre,National Institute for Medical Research,Mwanza,Tanzania.
authors.forename: George
authors.initials: G
authors.lastname: PrayGod
authors.affiliation: 5University Teaching Hospital,Lusaka,Zambia.
authors.forename: Lackson
authors.initials: L
authors.lastname: Kasonka
authors.affiliation: 5University Teaching Hospital,Lusaka,Zambia.
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
authors.affiliation: 1London School of Hygiene & Tropical Medicine,London WC1E 7HT,UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Filteau
mesh_terms: D000328:Adult; D000349:Africa; D019380:Anti-HIV Agents / Q000627:therapeutic use; D019587:Dietary Supplements; D004573:Electrolytes / Q000097:blood; D005260:Female; D005526:Food, Formulated; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008055:Lipids; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000150:complications / Q000178:diet therapy*; D008903:Minerals / Q000097:blood / Q000627:therapeutic use*; D010710:Phosphates / Q000097:blood; D010758:Phosphorus / Q000097:blood*; D011188:Potassium / Q000097:blood*; D014815:Vitamins / Q000627:therapeutic use*; D014882:Water-Electrolyte Balance
chemical_list: D019380:Anti-HIV Agents; D004573:Electrolytes; D008055:Lipids; D008903:Minerals; D010710:Phosphates; D014815:Vitamins; D010758:Phosphorus; D011188:Potassium
keywords:  ART antiretroviral therapy;  DAIDA Division of AIDS;  IQR interquartile range;  LNS lipid-based nutritional supplement;  LNS-VM lipid-based nutritional supplements fortified with vitamins and minerals;  NUSTART Nutritional Support for African Adults Starting Antiretroviral Therapy; Antiretroviral therapy; HIV; Malnutrition; Phosphate; Potassium