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Kidney Week

Abstract: FR-PO449

Predictors of Hypophosphatemia and Outcomes During Continuous Renal Replacement Therapy

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hendrix, Rachel Jenkins, Methodist University Hospital, Memphis, Tennessee, United States
  • Hastings, Margaret Colleen, University of Tennessee College of Medicine, Memphis, Tennessee, United States
  • Samarin, Michael J., Methodist University Hospital, Memphis, Tennessee, United States
  • Hudson, Joanna Q., University of Tennessee College of Medicine, Memphis, Tennessee, United States
Background

Hypophosphatemia occurs in up to 80% of patients undergoing continuous renal replacement therapy (CRRT) and is associated with poor outcomes. Whether pre-emptive phosphate supplementation is warranted in select patients has not been adequately explored. This single-center, retrospective cohort study evaluates predictors of hypophosphatemia and characterizes treatment approaches in adult patients undergoing CRRT.

Methods

Patients requiring CRRT for at least 12 hours were divided into two groups based on the presence or absence of hypophosphatemia as defined by serum phosphorus <2.5 mg/dL. Select laboratory values at baseline and during CRRT, medications and nutritional sources affecting phosphorus, and CRRT parameters were compared. Patient outcomes including acute kidney injury (AKI) resolution, freedom from renal replacement therapy (RRT) at hospital discharge, duration of intensive care unit (ICU) and hospital stay, duration of mechanical ventilation, and ICU mortality were evaluated.

Results

Seventy-two patients were included. The group was 43% female and 51% African American. CRRT was ordered for AKI in 83% and for end-stage renal disease in 15% of patients. Hypophosphatemia occurred in 45 patients (63%). Mean time to development of hypophosphatemia was 34 ± 22 hours. Patients who developed hypophosphatemia received a longer duration of CRRT (p=0.001), were more likely to have a diet ordered (p=0.005), less likely to have received calcium infusions (p=0.045), and had lower phosphorus (p=0.017) and potassium levels (p=0.038) and higher calcium levels at baseline (p=0.048). Development of hypophosphatemia was associated with an increased duration of ICU stay (p=0.014) but not with the other patient outcomes evaluated. Twenty-seven of the 45 patients (60%) who developed hypophosphatemia received phosphorus supplementation with near equal use of intravenous, oral, and combination routes. Only 16 patients (36%) achieved resolution of hypophosphatemia while on CRRT.

Conclusion

Hypophosphatemia is common, difficult to correct, and contributes to longer ICU stays in patients requiring CRRT. A pre-emptive approach to address hypophosphatemia including aggressive supplementation strategies to correct phosphorus is warranted in patients requiring CRRT.