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Kidney Week

Abstract: PO0204

Incidence of Hypophosphatemia During Continuous Renal Replacement Therapy: Baseline Data for a Quality Improvement Initiative

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Braga, Juarez R., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Juncos, Luis A., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Karakala, Nithin, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States

Hypophosphatemia is common among critically ill patients on continuous replacement therapy (CRRT). And low serum phosphorus is associated with difficulty to wean off from mechanical ventilation, longer hospital stays, and death. Our objective was to determine the incidence of hypophosphatemia among individuals receiving CRRT before implementing a phosphate replacement protocol as part of a quality improvement initiative.


We conducted a retrospective study of electronic health records from the University of Arkansas for Medical Sciences to identify consecutive adults diagnosed with acute kidney injury who received CRRT for at least 24 hours between May 2014 and September 2018. Laboratorial measurements of serum phosphorus collected while on CRRT were examined and hypophosphatemia was defined as levels <2.5 mg/dL.


A total of 685 unique participants received CRRT between 2014 and 2018. On average, 13.2 individuals were started on CRRT every month. Of 685 individuals, 446 were on CRRT for at least 24 hours for a total of 3,328 treatment days. The median number of days on CRTT was 4.3 (2.1-9.2). Those 446 individuals had 2,709 measurements of serum phosphorus. In total, 192 (43%) individuals were diagnosed with hypophosphatemia which occurred with a median time of 63.0 hours after initiation of CRRT. Hypophosphatemia developed in 25% of individuals within the first 2 days after starting dialysis.


Hypophosphatemia occurred frequently, and the incidence peaked at day 3. Although there is no ideal protocol about how to replace phosphate, our findings suggest that replacement should begin early after initiation of CRRT.