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Association between admission serum phosphate and risk of acute kidney injury in critically ill patients with rhabdomyolysis: A retrospective study based on MIMIC-Ⅲ

  • Author Footnotes
    1 Tao Wen and Zhi Mao contributed equally to this work.
    Tao Wen
    Footnotes
    1 Tao Wen and Zhi Mao contributed equally to this work.
    Affiliations
    Medical School of Chinese PLA, Beijing, China

    Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China

    Xinxing Bridge Clinic, Southern Medical District of Chinese PLA General Hospital, Beijing, China
    Search for articles by this author
  • Author Footnotes
    1 Tao Wen and Zhi Mao contributed equally to this work.
    Zhi Mao
    Footnotes
    1 Tao Wen and Zhi Mao contributed equally to this work.
    Affiliations
    Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
    Search for articles by this author
  • Chao Liu
    Affiliations
    Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
    Search for articles by this author
  • Xiaoli Wang
    Affiliations
    Medical School of Chinese PLA, Beijing, China
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  • Shufen Tian
    Affiliations
    Xinxing Bridge Clinic, Southern Medical District of Chinese PLA General Hospital, Beijing, China
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  • Feihu Zhou
    Correspondence
    Corresponding author at: Critical Care Medicine, Chinese People's Liberation Army General Hospital, 28 Fu-Xing Road, Beijing 100853, China.
    Affiliations
    Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
    Search for articles by this author
  • Author Footnotes
    1 Tao Wen and Zhi Mao contributed equally to this work.
Published:October 29, 2022DOI:https://doi.org/10.1016/j.injury.2022.10.024

      Abstract

      Background

      The incidence of acute kidney injury (AKI) is high in critically ill patients with rhabdomyolysis. Limited evidence was proved of the association between serum phosphate levels at intensive care unit (ICU) admission and the subsequent risk of AKI. Our study aims to assess if serum phosphate levels at admission were independently associated with AKI risk in these patients.

      Methods

      This study extracted and analyzed data from Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ, version1.4). Rhabdomyolysis was defined as a peak creatine kinase (CK) level higher than 1000 U/L. Serum phosphate was measured within the first day into the ICU and was categorized to 4 groups (<2.6, 2.6-3.4, 3.5-4.5, >4.5mg/dl). AKI was defined according to the Kidney Disease Improving Global Outcome (KDIGO) guidelines. Adjusted smoothing spline plots and multivariable logistic regressions were carried out to explode the association between serum phosphate and risk of AKI. Subgroup analyse was applied to verify the consistency of the association.

      Results

      Three hundred and twenty-one patients (68% male) diagnosed as rhabdomyolysis were eligible for this analysis. AKI occurred in 204 (64%) patients of total. Incidence of AKI with admission serum phosphate groups<2.6, 2.6-3.4, 3.5-4.5 and>4.5mg/dl were 53%, 57%, 68% and 76%, respectively. Smoothing spline curve showed that there was a positive curve between the elevated phosphate values and increasing risk of AKI, and there was no threshold saturation effect. In multivariable logistic regression, OR was 1.2 (95%CI 1.0-1.5, P=0.035, P trend=0.041) after adjusting confounders. Subgroup analyses proved the consistency of the relationship in these patients, possibly, except in the strata of potassium.

      Conclusion

      In rhabdomyolysis patients admitted to ICU, serum phosphate levels at admission were independently associated with an increased risk of AKI. As phosphate levels rise, the risk of AKI increased.

      Keywords

      Abbreviations:

      AKI (acute kidney injury), ICU (intensive care unit), MIMIC-Ⅲ (Medical Information Mart for Intensive CareⅢ), CK (creatine kinase), KDIGO (Kidney Disease Improving Global Outcome), APN (acute phosphate nephropathy), ICD-9 (9th International Classification of Diseases), CR (creatine), BUN (blood urea nitrogen), ALT (alanine transaminase), AST (aspartate aminotransferase), HCT (hematocrit), HGB (hemoglobin), WBC (white blood cell), RDW (red cell distribution width), AHF (acute heart failure), ALF (acute liver failure), AF (atrial fibrillation), ARDS (acute respiratory distress syndrome), MBP (mean blood pressure), HR (heart rate), RR (respiratory rate), RRT (renal replacement therapy), LOS (length of stay), SOFA (Sequential organ failure assessment), APSⅢ (acute physiology score Ⅲ), SD (standard deviation), IQR (inter quartile range), GAM (generalized additive model), OR (odds ratio), CI (confidence interval), TLS (tumorlysis syndrome), ATP (Adenosine Triphosphate), FGF23 (fibroblast growth factor 23), RCT (randomized controlled trial)
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