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Phosphate is a potential biomarker of disease severity and predicts adverse outcomes in acute kidney injury patients undergoing continuous renal replacement therapy

Authors
 Su-Young Jung  ;  Jaeyeol Kwon  ;  Seohyun Park  ;  Jong Hyun Jhee  ;  Hae-Ryong Yun  ;  HyoungNae Kim  ;  Youn Kyung Kee  ;  Chang-Yun Yoon  ;  Tae-Ik Chang  ;  Ea Wha Kang  ;  Jung Tak Park  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Seung Hyeok Han 
Citation
 PLoS One, Vol.13(2) : e0191290, 2018 
Journal Title
 PLoS One 
Issue Date
2018
MeSH
Acute Kidney Injury/metabolism/mortality/*pathology ; Adult ; Biomarkers/*metabolism ; Female ; Humans ; Hyperphosphatemia/metabolism ; Male ; Middle Aged ; Phosphates/blood/*metabolism ; Prognosis ; *Renal Replacement Therapy ; Severity of Illness Index
Abstract
Hyperphosphatemia is associated with mortality in patients with chronic kidney disease, and is common in critically ill patients with acute kidney injury (AKI); however, its clinical implication in these patients is unknown. We conducted an observational study in 1144 patients (mean age, 63.2 years; male, 705 [61.6%]) with AKI who received continuous renal replacement therapy (CRRT) between January 2009 and September 2016. Phosphate levels were measured before (0 h) and 24 h after CRRT initiation. We assessed disease severity using various clinical parameters. Phosphate at 0 h positively correlated with the Acute Physiology and Chronic Health Evaluation II (APACHE II; P < 0.001) and Sequential Organ Failure Assessment (SOFA; P < 0.001) scores, and inversely with mean arterial pressure (MAP; P = 0.02) and urine output (UO; P = 0.01). In a fully adjusted linear regression analysis for age, sex, Charlson comorbidity index (CCI), MAP, and estimated glomerular filtration rate (eGFR), higher 0 h phosphate level was significantly associated with high APACHE II (P < 0.001) and SOFA (P = 0.04) scores, suggesting that phosphate represents disease severity. A multivariable Cox model also showed that hyperphosphatemia was significantly associated with increased 28-day (HR 1.05, 95% CI 1.02-1.08, P = 0.001) and 90-day (HR 1.05, 95% CI 1.02-1.08, P = 0.001) mortality. Furthermore, patients with increased phosphate level during 24 h were at higher risk of death than those with stable or decreased phosphate levels. Finally, c-statistics significantly increased when phosphate was added to a model that included age, sex, CCI, body mass index, eGFR, MAP, hemoglobin, serum albumin, C-reactive protein, and APACHE II score. This study shows that phosphate is a potential biomarker that can reflect disease severity and predict mortality in critically ill patients receiving CRRT.
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DOI
10.1371/journal.pone.0191290
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
강신욱(Kang, Shin Wook) ORCID logo https://orcid.org/0000-0002-5677-4756
권재열(Kwon, Jaeyeol)
기연경(Kee, Youn Kyung)
김형래(Kim, Hyoung Rae)
박서현(Park, Seo Hyun)
박정탁(Park, Jung Tak) ORCID logo https://orcid.org/0000-0002-2325-8982
유태현(Yoo, Tae Hyun) ORCID logo https://orcid.org/0000-0002-9183-4507
윤창연(Yoon, Chang Yun)
윤해룡(Yun, Hae Ryong) ORCID logo https://orcid.org/0000-0002-7038-0251
정수영(Jung, Su Young)
지종현(Jhee, Jong Hyun)
한승혁(Han, Seung Hyeok) ORCID logo https://orcid.org/0000-0001-7923-5635
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/161934
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