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Admission hyperphosphatemia increases the risk of acute kidney injury in hospitalized patients

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Abstract

Background

Evidence on the association between elevated admission serum phosphate and risk of in-hospital acute kidney injury (AKI) is limited. The aim of this study was to assess the risk of AKI in hospitalized patients stratified by admission serum phosphate level.

Methods

This is a single-center retrospective study conducted at a tertiary referral hospital. All hospitalized adult patients who had admission phosphate measurement available between January and December 2013 were enrolled. Admission phosphate was categorized into 6 groups (< 2.4, 2.4–2.9, 2.9–3.4, 3.4–3.9, 3.9–4.4, and ≥ 4.4 mg/dl). The primary outcome was in-hospital AKI occurring after hospital admission. Logistic regression analysis was performed to obtain the odds ratio of AKI for various admission phosphate strata using the phosphate 2.4–2.9 mg/dl level (lowest incidence of AKI) as the reference group.

Results

After excluding patients with end-stage renal disease (ESRD), without serum phosphate measurement, and those with AKI at time of admission, a total of 5036 patients were studied. Phosphate levels of < 2.4 and ≥ 4.4 mg/dl were found in 458 (9.1%) and 585 (11.6%) patients, respectively. In-hospital AKI occurred in 595 (11.8%) patients. The incidence of AKI among patients with admission phosphate < 2.4, 2.4–2.9, 2.9–3.4, 3.4–3.9, 3.9–4.4, and ≥ 4.4 mg/dl was 10.5, 9.5, 11.8, 10.0, 12.8, and 17.9%, respectively. After adjusting for potential confounders, admission serum phosphate > 4.4 mg/dl was associated with an increased risk of developing AKI with an odds ratio of 1.72 (95% confidence interval 1.20–2.47), whereas admission serum phosphate levels < 4.4 mg/dl were not associated with development of AKI during hospitalization.

Conclusion

Elevated admission phosphate is associated with an increased risk for in-hospital AKI.

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Author information

Authors and Affiliations

  1. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Charat Thongprayoon, Wisit Cheungpasitporn, Michael A. Mao & Stephen B. Erickson

  2. Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA

    Charat Thongprayoon

  3. Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA

    Wisit Cheungpasitporn

  4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Ankit Sakhuja

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  1. Charat Thongprayoon
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  2. Wisit Cheungpasitporn
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  3. Michael A. Mao
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  4. Ankit Sakhuja
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  5. Stephen B. Erickson
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Contributions

All authors had access to the data and a role in writing the manuscript.

Corresponding author

Correspondence to Wisit Cheungpasitporn.

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Ethical approval

This study was approved by the Ethics Committee of Mayo Clinic. For this type of study formal consent is not required.

Informed consent

The Institutional Review Board affirmed our study and informed consent for patients with research authorization was waived.

Research involving human participants and/or animals

This is a single-center retrospective study conducted at a tertiary referral hospital.

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We do not have any financial or non-financial potential conflicts of interest.

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Thongprayoon, C., Cheungpasitporn, W., Mao, M.A. et al. Admission hyperphosphatemia increases the risk of acute kidney injury in hospitalized patients. J Nephrol 31, 241–247 (2018). https://doi.org/10.1007/s40620-017-0442-6

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  • DOI: https://doi.org/10.1007/s40620-017-0442-6

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