Severe Hypophosphatemia-Induced Acute Toxic-Metabolic Encephalopathy in Continuous Renal Replacement Therapy

Han, Se Hee; Park, Ha Yeol; Kim, Hyun Woo; Choi, Jong In; Kang, Da Yeong; Chung, Jong Hoon; Shin, Byung Chul

doi:10.5049/ebp.2019.17.2.62

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…Patients with long-term malnutrition and sepsis can induce hypophosphataemia, which can lead to central nervous system complications such as mental disorders and epilepsy. 17 18 These studies suggest that decreased blood phosphorus in patients with CKD may increase the chance of AAE. Fourth, normal concentration of uric acid has antioxidant capacity.…”

Section: Discussionmentioning

confidence: 99%

“…Third, abnormal blood phosphorus concentration is also a common complication of CKD. Patients with long-term malnutrition and sepsis can induce hypophosphataemia, which can lead to central nervous system complications such as mental disorders and epilepsy 17 18. These studies suggest that decreased blood phosphorus in patients with CKD may increase the chance of AAE.…”

Section: Discussionmentioning

confidence: 99%

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Retrospective case–control study on screening risk factors of antibiotic-associated encephalopathy in patients with chronic kidney disease

Wang

Liu

2022

BMJ Open

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ObjectiveThe renal excretion function of patients with chronic kidney disease (CKD) is reduced, and the nervous system toxic reactions of antibiotics are prone to occur. The purpose of this study is to screen out some risk factors for patients with CKD to suffer from antibiotic-associated encephalopathy (AAE).DesignA case–control study.SettingA tertiary hospital in China.ParticipantsThe medical records of patients who were hospitalised for CKD and infectious diseases in our hospital from January 2010 to December 2019. All patients used antibiotics to treat infectious diseases during hospitalisation. All patients were divided into two groups according to whether they developed AAE during hospitalisation. The patients with CKD without AAE were selected as the control group (n=120), and the patients with CKD with AAE were regarded as the AAE group (n=102).InterventionsThis study systematically analysed its clinical manifestations, laboratory examinations, prognosis, etc, and summarised the risk factors related to AAE in patients with CKD.Primary outcomeScreening risk factors of AAE in patients with CKD.ResultsLogistic regression analysis showed that coronary heart disease, as well as abnormal indicators of haemoglobin, albumin, uric acid and blood phosphorus were independent risk factors for patients with CKD with AAE (OR values were 4.137, 0.963, 0.849, 0.996 0.161, respectively, all p<0.05). The case fatality rate (Pearson χ2=7.524, p=0.006), rehospitalisation rate (Pearson χ2=6.187, p=0.013) and treatment costs (t=−8.44, p<0.001) in encephalopathy group are significantly higher than the control group.ConclusionsPatients with CKD with AAE will increase the case fatality rate and cause poor prognosis. Coronary heart disease, as well as decreased levels of haemoglobin, albumin, uric acid, and blood phosphorus are independent risk factors for patients with CKD with AAE. Timely intervention of these risk factors may reduce the incidence of AAE and improve the prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Retrospective case–control study on screening risk factors of antibiotic-associated encephalopathy in patients with chronic kidney disease

Wang

Liu

2022

BMJ Open

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“…Finally, attention is also needed to be paid to hypophosphatemia, a risk factor for encephalopathy development. Clinical cases of hypophosphatemia-induced encephalopathy after hemodialysis sessions have resolved after serum phosphate correction [106,107]. Likewise, hypophosphatemic encephalopathy is possible in continuous ambulatory peritoneal dialysis patients [108].…”

Section: The Impact Of Hypophosphatemia On Neurological Disordersmentioning

confidence: 99%

Phosphate in the Context of Cognitive Impairment and Other Neurological Disorders Occurrence in Chronic Kidney Disease

Rroji

Figurek

Viggiano

et al. 2022

IJMS

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The nervous system and the kidneys are linked under physiological states to maintain normal body homeostasis. In chronic kidney disease (CKD), damaged kidneys can impair the central nervous system, including cerebrovascular disease and cognitive impairment (CI). Recently, kidney disease has been proposed as a new modifiable risk factor for dementia. It is reported that uremic toxins may have direct neurotoxic (astrocyte activation and neuronal death) and/or indirect action through vascular effects (cerebral endothelial dysfunction, calcification, and inflammation). This review summarizes the evidence from research investigating the pathophysiological effects of phosphate toxicity in the nervous system, raising the question of whether the control of hyperphosphatemia in CKD would lower patients’ risk of developing cognitive impairment and dementia.

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“…Clinical manifestations of phosphate imbalance likewise vary widely, ranging from mild to life-threatening presentations. Phosphate imbalance can lead to tissue hypoxia, decreased myocardial contractility, arrhythmia, metabolic encephalopathy, and death [ 5 , 6 , 7 , 8 ]. Hypophosphatemia causes respiratory muscle weakness, decreased diaphragmatic contractility, and failure to wean from mechanical ventilation [ 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Associations between Phosphate Concentrations and Hospital Mortality in Critically Ill Patients Receiving Mechanical Ventilation

Kim

et al. 2022

JCM

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Phosphate concentrations change continuously throughout hospitalization; however, it is unclear which available phosphate measures are most clinically important for predicting hospital mortality. Therefore, we investigated phosphate concentrations in association with hospital mortality following admission to the intensive care unit. We retrospectively enrolled all adult patients receiving mechanical ventilation. Phosphate concentrations were divided into three categories: initially measured phosphate (iP); maximum–minimum phosphate values (ΔP); and phosphate arithmetic average (Pmean). In total, 175 patients were enrolled. The hospital mortality rate was 32.6%, and the most common primary diagnosis was respiratory failure. In multivariable logistic regression analyses, the odds ratios for hospital mortality in association with ΔP and Pmean values were 1.56 and 2.13, respectively (p < 0.0001). According to the obtained receiver operating characteristic curve, ΔP (0.75) and Pmean (0.72) each showed a fair predictive power for hospital mortality. In evaluating relative risks, we found that higher concentrations of Pmean and ΔP were each associated with a higher hospital mortality. ΔP and Pmean values were significantly associated with hospital mortality in critically ill patients, compared to iP. These findings showed that throughout hospitalization, it is important to reduce phosphate level fluctuations and maintain appropriate phosphate concentrations through consistent monitoring and corrections.

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Severe Hypophosphatemia-Induced Acute Toxic-Metabolic Encephalopathy in Continuous Renal Replacement Therapy

Cited by 4 publications

References 11 publications

Retrospective case–control study on screening risk factors of antibiotic-associated encephalopathy in patients with chronic kidney disease

Retrospective case–control study on screening risk factors of antibiotic-associated encephalopathy in patients with chronic kidney disease

Phosphate in the Context of Cognitive Impairment and Other Neurological Disorders Occurrence in Chronic Kidney Disease

Associations between Phosphate Concentrations and Hospital Mortality in Critically Ill Patients Receiving Mechanical Ventilation

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