Association of Hypophosphatemia during Continuous Kidney Replacement Therapy and Clinical Outcomes: A Systematic Review and Meta-Analysis.

ABSTRACT

INTRODUCTION: Hypophosphatemia is a common and potentially severe complication of continuous kidney replacement therapy (CKRT), but the evidence on the correlation between hypophosphatemia occurring during CKRT and clinical outcomes remains limited. METHODS: Electronic databases (PubMed, Embase, Web of Science, and the Cochrane database) were searched from inception to March 1, 2024. All possible studies that examined the following outcomes were included all-cause mortality, mechanical ventilation, intensive care unit (ICU) stay, and CKRT duration. RESULTS: A total of 8,631 patients from eight cohort studies were included. There was no statistical association between hypophosphatemia during CKRT and all-cause mortality in critically ill patients (OR 0.82, 95% CI 0.57-1.18, p = 0.28, I2 = 83%). However, hypophosphatemia was associated with longer duration of mechanical ventilation (WMD 80.30 h, 95% CI 31.37-129.22, p = 0.001, I2 = 60%). Furthermore, a longer length of ICU stay (WMD 2.76 d, 95% CI 2.50-3.02, p < 0.00001, I2 = 36%) and CKRT duration (WMD 51.51 h, 95% CI 2.69-100.34, p = 0.04, I2 = 96%) were observed in patients with hypophosphatemia. CONCLUSIONS: The association between hypophosphatemia and mortality in patients receiving CKRT was insufficient. However, hypophosphatemia during CKRT might be associated with adverse clinical outcomes for critically ill patients.