Phosphate level predicts mortality in acute kidney injury patients undergoing continuous kidney replacement therapy and has a U-shaped association with mortality in patients with high disease severity: a multicenter retrospective study
- Author:
Young Hwan LEE
1
;
Soyoung LEE
;
Yu Jin SEO
;
Jiyun JUNG
;
Jangwook LEE
;
Jae Yoon PARK
;
Tae Hyun BAN
;
Woo Yeong PARK
;
Sung Woo LEE
;
Kipyo KIM
;
Kyeong Min KIM
;
Hyosang KIM
;
Ji-Young CHOI
;
Jang-Hee CHO
;
Yong Chul KIM
;
Jeong-Hoon LIM
Author Information
- Publication Type:Original Article
- From:Kidney Research and Clinical Practice 2024;43(4):492-504
- CountryRepublic of Korea
- Language:EN
- Abstract: This study investigated the association between serum phosphate level and mortality in acute kidney injury (AKI) patients undergoing continuous kidney replacement therapy (CKRT) and evaluated whether this association differed according to disease severity. Methods: Data from eight tertiary hospitals in Korea were retrospectively analyzed. The patients were classified into four groups (low, normal, high, and very high) based on their serum phosphate level at baseline. The association between serum phosphate level and mortality was then analyzed, with further subgroup analysis being conducted according to disease severity. Results: Among the 3,290 patients identified, 166, 955, 1,307, and 862 were in the low, normal, high, and very high phosphate groups, respectively. The 90-day mortality rate was 63.9% and was highest in the very high group (76.3%). Both the high and very high groups showed a significantly higher 90-day mortality rate than did the normal phosphate group (high: hazard ratio [HR], 1.35, 95% confidence interval [CI], 1.21–1.51, p < 0.001; very high: HR, 2.01, 95% CI, 1.78–2.27, p < 0.001). The low group also exhibited a higher 90-day mortality rate than did the normal group among those with high disease severity (HR, 1.47; 95% CI, 1.09–1.99; p = 0.01) but not among those with low disease severity. Conclusion: High serum phosphate level predicted increased mortality in AKI patients undergoing CKRT, and low phosphate level was associated with increased mortality in patients with high disease severity. Therefore, serum phosphate levels should be carefully considered in critically ill patients with AKI.
