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:

Lee Young HwanORCID,Lee SoyoungORCID,Seo Yu JinORCID,Jung JiyunORCID,Lee JangwookORCID,Park Jae YoonORCID,Ban Tae HyunORCID,Park Woo YeongORCID,Lee Sung WooORCID,Kim KipyoORCID,Kim Kyeong MinORCID,Kim HyosangORCID,Choi Ji-YoungORCID,Cho Jang-HeeORCID,Kim Yong ChulORCID,Lim Jeong-HoonORCID

Abstract

Background: 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.

Funder

National Research Foundation of Korea

Korean Nephrology Research Foundation

Publisher

The Korean Society of Nephrology

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1. The 5th Asia Pacific AKI CRRT 2023: Best Movement to Critical Care, Save Lives;Kidney Research and Clinical Practice;2024-07-31

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