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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

 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 
 PLOS ONE, Vol.13(2) : e0191290, 2018 
Journal Title
Issue Date
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
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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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
Kwon, Jaeyeol(권재열)
Kee, Youn Kyung(기연경)
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
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