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

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

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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 0hour of ?4.5mg/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.

Original languageEnglish
Article numbere4542
JournalMedicine (United States)
Volume95
Issue number36
DOIs
Publication statusPublished - 2016 Jan 1

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Renal Replacement Therapy
Acute Kidney Injury
Electrolytes
Minerals
Hyperphosphatemia
Phosphates
Mortality
Hypophosphatemia
Hypokalemia
Randomized Controlled Trials
Sodium

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Jung, Su Young ; Kim, Hyunwook ; Park, Seohyun ; Jhee, Jong Hyun ; Yun, Hae Ryong ; Kim, Hyoungnae ; Kee, Youn Kyung ; Yoon, Chang Yun ; Oh, Hyung Jung ; Chang, Tae Ik ; Park, Jung Tak ; Yoo, Tae Hyun ; Kang, Shin Wook ; Lee, Hajeong ; Kim, Dong Ki ; Han, Seung Hyeok. / Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy. In: Medicine (United States). 2016 ; Vol. 95, No. 36.
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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 0hour of ?4.5mg/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.",
author = "Jung, {Su Young} and Hyunwook Kim and Seohyun Park and Jhee, {Jong Hyun} and Yun, {Hae Ryong} and Hyoungnae Kim and Kee, {Youn Kyung} and Yoon, {Chang Yun} and Oh, {Hyung Jung} and Chang, {Tae Ik} and Park, {Jung Tak} and Yoo, {Tae Hyun} and Kang, {Shin Wook} and Hajeong Lee and Kim, {Dong Ki} and Han, {Seung Hyeok}",
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Jung, SY, Kim, H, Park, S, Jhee, JH, Yun, HR, Kim, H, Kee, YK, Yoon, CY, Oh, HJ, Chang, TI, Park, JT, Yoo, TH, Kang, SW, Lee, H, Kim, DK & Han, SH 2016, 'Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy', Medicine (United States), vol. 95, no. 36, e4542. https://doi.org/10.1097/MD.0000000000004542

Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy. / Jung, Su Young; Kim, Hyunwook; Park, Seohyun; Jhee, Jong Hyun; Yun, Hae Ryong; Kim, Hyoungnae; Kee, Youn Kyung; Yoon, Chang Yun; Oh, Hyung Jung; Chang, Tae Ik; Park, Jung Tak; Yoo, Tae Hyun; Kang, Shin Wook; Lee, Hajeong; Kim, Dong Ki; Han, Seung Hyeok.

In: Medicine (United States), Vol. 95, No. 36, e4542, 01.01.2016.

Research output: Contribution to journalArticle

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T1 - Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy

AU - Jung, Su Young

AU - Kim, Hyunwook

AU - Park, Seohyun

AU - Jhee, Jong Hyun

AU - Yun, Hae Ryong

AU - Kim, Hyoungnae

AU - Kee, Youn Kyung

AU - Yoon, Chang Yun

AU - Oh, Hyung Jung

AU - Chang, Tae Ik

AU - Park, Jung Tak

AU - Yoo, Tae Hyun

AU - Kang, Shin Wook

AU - Lee, Hajeong

AU - Kim, Dong Ki

AU - Han, Seung Hyeok

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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 0hour of ?4.5mg/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.

AB - 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 0hour of ?4.5mg/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.

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