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Abstract: TH-PO017

Admission Calcium-Phosphate Product Levels and Risk of AKI in Hospitalized Patients

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Mao, Michael A., Mayo Clinic, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Thongprayoon, Charat, Bassett Medical Center, Cooperstown, New York, United States
  • Erickson, Stephen B., Mayo Clinic, Rochester, Minnesota, United States

An increased serum calcium-phosphate product (CaP) can result in acute kidney injury (AKI) due to tubular and interstitial calcium phosphate deposits. In addition, CaP of >55 mg2/dL2 is associated with systemic calcification. However, the risk of AKI development among hospitalized patients with different calcium-phosphate product levels on admission remains unclear.


All adult hospitalized patients who had both admission serum calcium and phosphate levels available between years 2009 and 2013 were enrolled. Admission CaP was categorized based on its distribution into six groups (<22, 22-<27, 27-<32, 32-<37, 37-<42 and ≥42 mg2/dL2). The odds ratio (OR) of in-hospital mortality by admission CaP, using the CaP category of <22 mg2/dL2 as the reference group, was obtained by logistic regression analysis.


After excluding patients with end stage renal disease (ESRD), without serum creatinine measurement, and those with AKI at presentation, a total of 9,864 patients were studied. In-hospital AKI occurred in 1,478 (15.0%) patients. The incidence of AKI among patients with admission CaP <22, 22-<27, 27-<32, 32-<37, 37-<42 and ≥42 mg2/dL2 was 11.1%, 12.4%, 14.9%, 15.2%, 17.5%, and 19.9%, respectively. After adjusting for potential confounders, CaP >37 mg2/dL2 was associated with an increased risk of developing AKI, with ORs of 1.53 (95% CI 1.19-1.96) and 1.63 (95% CI 1.25-2.14) in patients with admission CaP 37-<42 and ≥42, respectively. Among a subgroup of patients with available serum albumin, after adjusting for potential confounders, corrected CaP >27 mg2/dL2 was associated with an increased risk of developing AKI with ORs of 1.50 (95% CI 1.06-2.15), 1.49 (95% CI 1.06-2.13), 1.85 (95% CI 1.30-2.67) and 1.69 (95% CI 1.16-2.49) when CaP were within 27-<32, 32-<37, 37-<42 and ≥42 mg2/dL2, respectively.


Elevated admission CaP was associated with an increased risk for in-hospital AKI.