Department of Pharmacy, Regional One Health, Memphis, Tennessee, USA.
Department of Medicine, Regional One Health, Memphis, Tennessee, USA.
J Burn Care Res. 2023 Mar 2;44(2):234-239. doi: 10.1093/jbcr/irac047.
Patients with severe thermal injuries have increased metabolic demands necessitating frequent phosphate supplementation. Patients with acute renal failure may have less requirements, due to reduced elimination. However, patients being supported with renal replacement therapy have varying degree of requirements. Little published evidence depicts the incidence of hypophosphatemia and repletion requirements in patients with severe thermal injuries treated with high-volume hemofiltration (HVHF) and a high-flux membrane. The objective of this retrospective chart review was to determine the incidence of hypophosphatemia and characterize repletion requirements and response in this population. Enrolled patients had at least 20% TBSA thermal injuries and required continuous hemofiltration with prefilter replacement fluid doses ≥35 mL/kg IBW/hr. A randomly selected cohort without acute kidney injury (AKI) and matched based on age and extent of TBSA was used to compare phosphorus requirements over an initial 14-day period. Demographics, diet, and variables affecting phosphorus concentrations were collected. Sixteen patients were included in the retrospective HVHF group and 16 patients in a case-control cohort to better depict the impact of HVHF. The average age was 60.2 ± 15.1 years and median TBSA was 30% (23.4, 56.3) in the HVHF group, compared to 53.3 ± 16.4 years (P = .22) and TBSA 29% (26.4, 33.9; P = .73). All patients in the HVHF group were started on HVHF with a 1.6 m2 polyethersulfone membrane for AKI. As expected, the HVHF group exhibited statistically higher than normal baseline potassium and phosphorous laboratory values. The HVHF group experienced more days with hypophosphatemia (49.6 ± 12.4% vs 29.3 ± 16.3%, P = .012), despite 0.75 mmol/kg/day phosphorous supplementation (compared to 0.66 mmol/kg/day for the control group, P = .45). Patients with longer durations of HVHF therapy experienced increasing risk of hypophosphatemia, reaching 100% by the end of the study period. This study demonstrates severe thermally injured patients receiving HVHF for AKI are at increased risk for hypophosphatemia, and require high phosphate supplementation.
严重烧伤患者代谢需求增加，需要频繁补充磷酸盐。急性肾衰竭患者的需求可能较少，因为排泄减少。然而，接受肾脏替代治疗的患者有不同程度的需求。很少有文献描述在接受高容量血液滤过 (HVHF) 和高通量膜治疗的严重烧伤患者中，低磷血症的发生率和补充需求。本回顾性图表研究的目的是确定接受 HVHF 治疗的严重烧伤患者低磷血症的发生率，并描述该人群的补充需求和反应。入组患者的烧伤面积至少为 20%TBSA，需要持续血液滤过，前滤器置换液剂量≥35ml/kgIBW/hr。选择一组无急性肾损伤 (AKI) 的随机队列，并根据年龄和 TBSA 范围进行匹配，以比较初始 14 天内的磷需求。收集了人口统计学、饮食和影响磷浓度的变量。回顾性 HVHF 组纳入 16 例患者，病例对照队列纳入 16 例患者，以更好地描述 HVHF 的影响。HVHF 组的平均年龄为 60.2 ± 15.1 岁，中位 TBSA 为 30%（23.4，56.3），而 HVHF 组为 53.3 ± 16.4 岁（P=0.22）和 TBSA 29%（26.4，33.9；P=0.73）。HVHF 组所有患者均因 AKI 开始接受 HVHF，使用 1.6m2 聚醚砜膜。正如预期的那样，HVHF 组的钾和磷实验室值明显高于正常值。尽管 HVHF 组每天补充 0.75mmol/kg 的磷（而对照组每天补充 0.66mmol/kg 的磷，P=0.45），但 HVHF 组出现低磷血症的天数更多（49.6±12.4%比 29.3±16.3%，P=0.012）。HVHF 治疗时间较长的患者发生低磷血症的风险增加，研究结束时达到 100%。本研究表明，因 AKI 接受 HVHF 治疗的严重烧伤患者发生低磷血症的风险增加，需要高磷补充。
