Incidence and aetiology of renal phosphate loss in patients with hypophosphatemia in the intensive care unit.

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Incidence and aetiology of renal phosphate loss in patients with hypophosphatemia in the intensive care unit.

Intensive Care Med. 2013 Jul 20;

Authors: Bech A, Blans M, Telting D, de Boer H

Abstract
BACKGROUND: Hypophosphatemia is a common finding in patients in the intensive care unit (ICU). Its cause is often poorly understood.
PURPOSE: The aim of this study was to understand the incidence of renal phosphate loss in ICU-related hypophosphatemia, and to examine the role of phosphaturic hormones in its etiology.
METHODS: Plasma phosphate levels were measured on day 1, 3, 5 and 7 in 290 consecutive patients admitted to the ICU. Renal phosphate handling and phosphaturic hormones were studied in a subset of patients with phosphate levels <0.6 mmol/L. Renal phosphate loss was defined as a TmP/gfr < 0.6 mmol/L.
MAIN RESULTS: Hypophosphatemia developed in 24 % of all patients. This mainly occurred within the first 3 days of stay and in patients with serum creatinine levels <150 μmol/L. Renal phosphate loss was present in 80 % of patients who developed hypophosphatemia, and was not related to serum levels of parathyroid hormone (PTH), PTH-related protein (PTH-rp), fibroblast growth factor 23 (FGF-23), or calcitonin.
CONCLUSION: Hypophosphatemia in the ICU is commonly associated with renal phosphate loss. It mainly occurs within the first 3 days of admission, in particular in patients with preserved renal function. Renal phosphate loss is not explained by elevated PTH, PTH-rp, FGF-23 or calcitonin levels.

PMID: 23873336 [PubMed - as supplied by publisher]

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