Department of Internal Medicine-Campus Innenstadt, University of Munich, Ziemssenstr.1, 80336 Munich, Germany.
Int Urol Nephrol. 2013 Feb;45(1):191-7. doi: 10.1007/s11255-011-0112-x. Epub 2012 Jan 7.
Hypophosphatemia during renal replacement therapy (RRT) is common in critically ill patients with acute kidney injury (AKI). The clinical consequences of RRT-induced phosphate depletion are not well defined in this patient population, and there is no evidence that intravenous sodium phosphate supplementation (PS) prevents the clinical sequelae of acute hypophosphatemia. The purpose of this retrospective analysis of the Acute Renal Support Registry of the University of Munich was to examine the association between severe hypophosphatemia and severity of and recovery from AKI.
289 ICU patients with AKI on intermittent hemodialysis (IHD) were included in the study. One hundred and forty-nine patients received PS during IHD. Outcomes were short-term (at discharge) and long-term (at 1 year) recovery of renal function and mortality.
The two patient groups did not differ in demographics, clinical features, renal characteristics, and frequency of hypophosphatemia at initiation of IHD. Without PS, the frequency of hypophosphatemia increased from 20 to 35%. Severe hypophosphatemia was found in 50% of these patients. By comparison, PS was not associated with an increased frequency of hypophosphatemia. Compared with patients with acute phosphate depletion, patients receiving PS developed less oliguria during IHD, had shorter duration of AKI, higher incidence of complete renal recovery at discharge, and a lower risk of de novo chronic kidney disease. Hypophosphatemia was associated with higher all-cause in-hospital mortality and higher risk of long-term mortality.
This multicenter study indicates for the first time that hypophosphatemia during IHD adversely affects short- and long-term outcome of critically-ill patients with AKI. The clinical consequences of the acute hypophosphatemic syndrome may be prevented by PS.
在伴有急性肾损伤（AKI）的危重症患者中，肾脏替代治疗（RRT）期间发生低磷血症较为常见。在该患者人群中，RRT 诱导的磷耗竭的临床后果尚未明确，且尚无证据表明静脉补充磷酸钠盐（PS）可预防急性低磷血症的临床后果。本项对慕尼黑大学急性肾脏支持登记处的回顾性分析旨在研究严重低磷血症与 AKI 的严重程度和恢复之间的关联。
本研究纳入了 289 例接受间歇性血液透析（IHD）的 AKI 重症监护病房（ICU）患者。149 例患者在 IHD 期间接受了 PS 治疗。结局包括短期（出院时）和长期（1 年时）肾功能恢复情况和死亡率。
两组患者在人口统计学特征、临床特征、肾脏特征和 IHD 起始时低磷血症的频率方面均无差异。未接受 PS 治疗时，低磷血症的频率从 20%增加至 35%。其中 50%的患者发生严重低磷血症。相比之下，PS 治疗并未增加低磷血症的发生频率。与急性磷耗竭患者相比，接受 PS 治疗的患者在 IHD 期间发生少尿的情况较少，AKI 的持续时间较短，出院时完全恢复肾功能的发生率更高，且新发慢性肾脏病的风险更低。低磷血症与全因院内死亡率升高和长期死亡率升高相关。
本多中心研究首次表明，IHD 期间的低磷血症会对伴有 AKI 的危重症患者的短期和长期结局产生不利影响。PS 可预防急性低磷血症综合征的临床后果。
