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

Jung, Su Young; Kim, Hyun‐Wook; Park, Seohyun; Jhee, Jong Hyun; Yun, Hae‐Ryong; Kim, Hyoungnae; Kee, Youn Kyung; Yoon, Chang Yun; Oh, Hyung Jung; Chang, Tae Ik; Park, Sun-Hee; Yoo, Tae Hyun; Kang, Shin Wook; Lee, Ha Jeong; Kim, Yon Su; Han, Seung Hyeok

doi:10.1097/md.0000000000004542

Cited by 36 publications

(40 citation statements)

References 45 publications

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“…Increased serum phosphate levels have been associated with a higher risk of developing AKI among hospitalized patients, 79 as well as a higher risk of short-term mortality among patients with established AKI (Table 3). [80][81][82] The mechanisms responsible for these findings are unclear. However, rapid and severe increases in the extracellular phosphate concentration can result in acute phosphate nephropathy, in which calcium phosphate deposition is found in the tubular lumina, tubular epithelia, and, less commonly, the peritubular interstitium.…”

Section: Clinical Relevance Of Hyperphosphatemia In Akimentioning

confidence: 99%

Dysregulated Mineral Metabolism in AKI

Leaf

Christov

2019

Seminars in Nephrology

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Dysregulated mineral metabolism is a nearly universal sequalae of acute kidney injury (AKI). Abnormalities in circulating mineral metabolites observed in patients with AKI include hypocalcemia, hyperparathyroidism, hyperphosphatemia, decreased vitamin D metabolite levels, and increased fibroblast growth factor 23 levels. We review the pathophysiology of dysregulated mineral metabolism in AKI with a focus on calcium, phosphate, parathyroid hormone, and vitamin D metabolites. We discuss how mineral metabolite levels can serve as novel prognostic markers for incident AKI and other related outcomes in various clinical settings. Finally, we discuss how vitamin D metabolites potentially could be used as novel therapeutic agents for AKI prevention and treatment.

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Section: Clinical Relevance Of Hyperphosphatemia In Akimentioning

confidence: 99%

Dysregulated Mineral Metabolism in AKI

Leaf

Christov

2019

Seminars in Nephrology

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“…Hyperphosphatemia is also a common condition in patients with AKI. It is likely due to decreased phosphate removal and secondary hyperparathyroidism as a result of reduced kidney function [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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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“…In a 2015 meta-analysis of 12 cohort studies of non-dialysis CKD patients (n = 25,500), an independent association of hyperphosphatemia and risk of CKD progression and mortality was observed [76]. Collectively, the association of serum phosphorus with cardiovascular events and mortality begins at a high normal range of phosphorus [77,78,79] and occurs in patients at all stages of CKD [80,81], as well as in critically ill patients with dialysis-requiring acute kidney injury [75]. Causal relationship between hyperphosphatemia and CKD progression and mortality, however, remains to be established.…”

Section: Derangements Of Bone Mineral Metabolismmentioning

confidence: 99%

“…More importantly, hyperphosphatemia promotes osteo-chondrogenic transformation and apoptosis of vascular smooth muscle cells and vessel wall collagen matrix accumulation and mineralization [68,69,70]. Large cohort studies have consistently shown that hyperphosphatemia is associated with vascular calcification [71], CKD progression [72] and increased risk of cardiovascular events and mortality [73,74,75]. In a 2015 meta-analysis of 12 cohort studies of non-dialysis CKD patients (n = 25,500), an independent association of hyperphosphatemia and risk of CKD progression and mortality was observed [76].…”

Section: Derangements Of Bone Mineral Metabolismmentioning

confidence: 99%

Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure

Dhondup

Qian²

2017

Blood Purif

156

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The kidneys play a pivotal role in the regulation of electrolyte and acid-base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. As chronic kidney disease (CKD) has become a worldwide epidemic, medical providers are increasingly confronted with such problems. Adequate diagnosis and treatment will minimize complications and can potentially be lifesaving. In this review, we discuss the current understanding of the disease process, clinical presentation, diagnosis and treatment strategies, integrating up-to-date knowledge in the field. Although electrolyte and acid-base derangements are significant causes of morbidity and mortality in CKD and end-stage renal disease patients, they can be effectively managed through a timely institution of combined preventive measures and pharmacological therapy. Exciting advances and several upcoming outcome trials will provide further information to guide treatment and improve patient outcomes.

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

Abstract: Supplemental Digital Content is available in the text

Cited by 36 publications

References 45 publications

Dysregulated Mineral Metabolism in AKI

Dysregulated Mineral Metabolism in AKI

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

Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure

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