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Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy

Authors
 Su-Young Jung  ;  Hyunwook Kim  ;  Seohyun Park  ;  Jong Hyun Jhee  ;  Hae-Ryong Yun  ;  Hyoungnae Kim  ;  Youn Kyung Kee  ;  Chang-Yun Yoon  ;  Hyung Jung Oh  ;  Tae Ik Chang  ;  Jung Tak Park  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Hajeong Lee  ;  Dong Ki Kim  ;  Seung Hyeok Han 
Citation
 MEDICINE, Vol.95(36) : 4542, 2016 
Journal Title
 MEDICINE 
ISSN
 0025-7974 
Issue Date
2016
MeSH
Acute Kidney Injury/blood* ; Acute Kidney Injury/complications ; Acute Kidney Injury/mortality ; Aged ; Electrolytes/blood* ; Female ; Humans ; Hyperphosphatemia/blood ; Hyperphosphatemia/etiology ; Hyperphosphatemia/mortality ; Length of Stay ; Male ; Middle Aged ; Prospective Studies ; Renal Replacement Therapy/adverse effects ; Renal Replacement Therapy/methods* ; Renal Replacement Therapy/mortality ; Republic of Korea/epidemiology ; Sepsis/blood ; Sepsis/complications ; Trace Elements/blood
Keywords
acute kidney injury (AKI) ; continuous renal replacement therapy (CRRT) ; electrolyte ; mineral
Abstract
Electrolyte and mineral disturbances remain a major concern in patients undergoing continuous renal replacement therapy (CRRT); however, it is not clear whether those imbalances are associated with adverse outcomes in patients with septic acute kidney injury (AKI) undergoing CRRT. We conducted a post-hoc analysis of data from a prospective randomized controlled trial. A total of 210 patients with a mean age of 62.2 years (136 [64.8%] males) in 2 hospitals were enrolled. Levels of sodium, potassium, calcium, and phosphate measured before (0?hour) and 24 hours after CRRT initiation. Before starting CRRT, at least 1 deficiency and excess in electrolytes or minerals were observed in 126 (60.0%) and 188 (67.6%) patients, respectively. The excess in these parameters was greatly improved, whereas hypokalemia and hypophosphatemia became more prevalent at 24 hours after CRRT. However, 1 and 2 or more deficiencies in those parameters at the 2 time points were not associated with mortality. However, during 28 days, 89 (71.2%) deaths occurred in patients with phosphate levels at 0?hour of ≥4.5?mg/dL as compared with 49 (57.6%) in patients with phosphate levels <4.5?mg/dL. The 90-day mortality was also significantly higher in patients with hyperphosphatemia. Similarly, in 184 patients who survived at 24 hours after CRRT, hyperphosphatemia conferred a 2.2-fold and 2.6-fold increased risk of 28- and 90-day mortality, respectively. The results remained unaltered when the serum phosphate level was analyzed as a continuous variable. Electrolyte and mineral disturbances are common, and hyperphosphatemia may predict poor prognosis in septic AKI patients undergoing CRRT.
Files in This Item:
T201603452.pdf Download
DOI
10.1097/MD.0000000000004542
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kee, Youn Kyung(기연경)
Kim, Hyun Wook(김현욱) ORCID logo https://orcid.org/0000-0002-4274-7562
Kim, Hyoung Rae(김형래)
Park, Seo Hyun(박서현)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yoon, Chang Yun(윤창연)
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Jung, Su Young(정수영)
Jhee, Jong Hyun(지종현)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/151932
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