Elevated admission serum calcium phosphate product as an independent risk factor for acute kidney injury in hospitalized patients

Cheungpasitporn, Wisit; Mao, Michael A; Harrison, Andrew M.; Erickson, Stephen B.

doi:10.1080/21548331.2019.1568719

Cited by 19 publications

(21 citation statements)

References 54 publications

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“…An increase in serum calcium is associated with incident heart failure [33] and possible hypercalcemia-induced neuronal injury among patients with acute ischemic stroke [34]. Moreover, an increase in serum calcium may result in AKI via renal vasoconstriction and nephrogenic diabetes insipidus-induced volume depletion [35][36][37][38][39][40]. In our current study, we also adjusted AKI during hospitalization in our multivariable logistic regression analysis, and we found that the upward trend of serum calcium change of >1.0 mg/dL was significantly associated with increased in-hospital mortality, while the highest mortality (6.3-fold increased mortality) was observed in patients with an absolute increase in serum calcium level ≥2.0 mg/dL.…”

Section: Discussionmentioning

confidence: 99%

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

et al. 2020

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Background and objectives: Calcium concentration is strictly regulated at both the cellular and systemic level, and changes in serum calcium levels can alter various physiological functions in various organs. This study aimed to assess the association between changes in calcium levels during hospitalization and mortality. Materials and Methods: We searched our patient database to identify all adult patients admitted to our hospital from January 1st, 2009 to December 31st, 2013. Patients with ≥2 serum calcium measurements during the hospitalization were included. The serum calcium changes during the hospitalization, defined as the absolute difference between the maximum and the minimum calcium levels, were categorized into five groups: 0–0.4, 0.5–0.9, 1.0–1.4, 1.5–1.9, and ≥2.0 mg/dL. Multivariable logistic regression was performed to assess the independent association between calcium changes and in-hospital mortality, using the change in calcium category of 0–0.4 mg/dL as the reference group. Results: Of 9868 patients included in analysis, 540 (5.4%) died during hospitalization. The in-hospital mortality progressively increased with higher calcium changes, from 3.4% in the group of 0–0.4 mg/dL to 14.5% in the group of ≥2.0 mg/dL (p < 0.001). When adjusted for age, sex, race, principal diagnosis, comorbidity, kidney function, acute kidney injury, number of measurements of serum calcium, and hospital length of stay, the serum calcium changes of 1.0–1.4, 1.5–1.9, and ≥2.0 mg/dL were significantly associated with increased in-hospital mortality with odds ratio (OR) of 1.55 (95% confidence interval (CI) 1.15–2.10), 1.90 (95% CI 1.32–2.74), and 3.23 (95% CI 2.39–4.38), respectively. The association remained statistically significant when further adjusted for either the lowest or highest serum calcium. Conclusion: Larger serum calcium changes in hospitalized patients were progressively associated with increased in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

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“…Serum phosphate levels have been identified as strong predictors on clinical outcomes, including hospital mortality [4]. While hypophosphatemia is shown to be independently associated with increased mortality among critically ill patients, malnourished individuals, and patients with sepsis [5][6][7], hyperphosphatemia is associated with poor clinical outcomes including mortality in chronic kidney disease (CKD) [8,9], hemodialysis [10,11], acute coronary syndrome [12], and general patient population [13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

“…While previous studies have focused on the impact of serum phosphate disorders (hypophosphatemia and hyperphosphatemia) [5][6][7][13][14][15][16][17], knowledge about the significance of changes in serum phosphate level and allcause mortality remains scarce. Among patients on maintenance hemodialysis, a recent study demonstrated that high variability of serum phosphate was independently correlated with increased all-cause and cardiovascular mortality, while stable serum phosphate levels and low serum phosphate variability were associated with reduced patient mortality [10].…”

Section: Introductionmentioning

confidence: 99%

Impact of serum phosphate changes on in-hospital mortality

et al. 2020

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Background Fluctuations in serum phosphate levels increased mortality in end-stage renal disease patients. However, the impacts of serum phosphate changes in hospitalized patients remain unclear. This study aimed to test the hypothesis that serum phosphate changes during hospitalization were associated with in-hospital mortality. Methods We included all adult hospitalized patients from January 2009 to December 2013 that had at least two serum phosphate measurements during their hospitalization. We categorized in-hospital serum phosphate changes, defined as the absolute difference between the maximum and minimum serum phosphate, into 5 groups: 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL. Using serum phosphate change group of 0–0.6 mg/dL as the reference group, the adjusted odds ratio of in-hospital mortality for various serum phosphate change groups was obtained by multivariable logistic regression analysis. Results A total of 28,149 patients were studied. The in-hospital mortality in patients with serum phosphate changes of 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL was 1.5, 2.0, 3.1, 4.4, and 10.7%, respectively (p < 0.001). When adjusted for confounding factors, larger serum phosphate changes were associated with progressively increased in-hospital mortality with odds ratios of 1.35 (95% 1.04–1.74) in 0.7–1.3 mg/dL, 1.98 (95% CI 1.53–2.55) in 1.4–2.0 mg/dL, 2.68 (95% CI 2.07–3.48) in 2.1–2.7 mg/dL, and 5.04 (95% CI 3.94–6.45) in ≥2.8 mg/dL compared to serum phosphate change group of 0–0.6 mg/dL. A similar result was noted when we further adjusted for either the admission or mean serum phosphate during hospitalization. Conclusion Greater serum phosphate changes were progressively associated with increased in-hospital mortality.

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“…Acute kidney injury (AKI) is a highly complicated clinical disorder that is widely characterized by rapid rate of reduced rate of glomerular filtration (GFR), demonstrated by a rise in serum creatinine (SCr) concentration or oliguria, or both [1][2][3][4][5]. AKI is common among hospitalized patients, affecting approximately 10%-20% of hospitalized patients, of whom 10% require renal replacement therapy (RRT) [6][7][8][9][10][11]. Among critically ill patients, the incidence of AKI has been reported as high as 45-50% [2,12].…”

Section: Introductionmentioning

confidence: 99%

Diagnostics, Risk Factors, Treatment and Outcomes of Acute Kidney Injury in a New Paradigm

Thongprayoon

Hansrivijit

Kovvuru

et al. 2020

JCM

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Acute kidney injury (AKI) is a common clinical condition among patients admitted in the hospitals. The condition is associated with both increased short-term and long-term mortality. With the development of a standardized definition for AKI and the acknowledgment of the impact of AKI on patient outcomes, there has been increased recognition of AKI. Two advances from past decades, the usage of computer decision support and the discovery of AKI biomarkers, have the ability to advance the diagnostic method to and further management of AKI. The increasingly widespread use of electronic health records across hospitals has substantially increased the amount of data available to investigators and has shown promise in advancing AKI research. In addition, progress in the finding and validation of different forms of biomarkers of AKI within diversified clinical environments and has provided information and insight on testing, etiology and further prognosis of AKI, leading to future of precision and personalized approach to AKI management. In this this article, we discussed the changing paradigms in AKI: From mechanisms to diagnostics, risk factors, and management of AKI.

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Elevated admission serum calcium phosphate product as an independent risk factor for acute kidney injury in hospitalized patients

Cited by 19 publications

References 54 publications

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

Impact of serum phosphate changes on in-hospital mortality

Diagnostics, Risk Factors, Treatment and Outcomes of Acute Kidney Injury in a New Paradigm

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