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Content Provider | World Health Organization (WHO)-Global Index Medicus |
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Author | Sharma, Shilpa Brugnara, Carlo Betensky, Rebecca A. Waikar, Sushrut S. |
Description | Author Affiliation: Sharma S ( Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts); Brugnara C ( Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts); Betensky RA ( Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.); Waikar SS ( Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts) |
Abstract | BACKGROUND AND OBJECTIVES: Hypophosphatemia is a frequent complication during continuous renal replacement therapy (CRRT), a dialytic technique used to treat AKI in critically ill patients. This study sought to confirm that phosphate depletion during CRRT may decrease red blood cell (RBC) concentration of 2,3-diphosphoglycerate (2,3-DPG), a crucial allosteric effector of hemoglobin's (Hgb's) affinity for oxygen, thereby leading to impaired oxygen delivery to peripheral tissues. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Phosphate mass balance studies were performed in 20 patients with severe AKI through collection of CRRT effluent. RBC concentrations of 2,3-DPG, venous blood gas pH, and oxygen partial pressure required for 50% hemoglobin saturation (P50) were measured at CRRT initiation and days 2, 4, and 7. Similar measurements were obtained on days 0 and 2 in a reference group of 10 postsurgical patients, most of whom did not have AKI. Associations of 2,3-DPG with laboratory parameters and clinical outcomes were examined using mixed-effects and Cox regression models. RESULTS: Mean 2,3-DPG levels decreased from a mean (±SD) of 13.4±3.4 µmol/g Hgb to 11.0±3.1 µmol/g Hgb after 2 days of CRRT (P<0.001). Mean hemoglobin saturation P50 levels decreased from 29.7±4.4 mmHg to 26.7±4.0 mmHg (P<0.001). No significant change was seen in the reference group. 2,3-DPG levels after 2 days of CRRT were not significantly lower than those in the reference group on day 2. Among patients receiving CRRT, 2,3-DPG decreased by 0.53 µmol/g Hgb per 1 g phosphate removed (95% confidence interval 0.38 to 0.68 µmol/g Hgb; P<0.001). Greater reductions in 2,3-DPG were associated with higher risk for death (hazard ratio, 1.43; 95% confidence interval, 1.09 to 1.88; P=0.01). CONCLUSIONS: CRRT-induced phosphate depletion is associated with measurable reductions in RBC 2,3-DPG concentration and a shift in the O2:Hgb affinity curve even in the absence of overt hypophosphatemia. 2,3-DPG reductions may be associated with higher risk for in-hospital death and represent a potentially avoidable complication of CRRT. |
File Format | HTM / HTML |
ISSN | 15559041 |
e-ISSN | 1555905X |
DOI | 10.2215/CJN.02160214 |
Journal | Clinical Journal of the American Society of Nephrology |
Issue Number | 1 |
Volume Number | 10 |
Language | English |
Publisher | American Society of Nephrology |
Publisher Date | 2015-01-07 |
Publisher Place | United States |
Access Restriction | Open |
Subject Keyword | Research Support, N.i.h., Extramural Therapy Research Support, Non-u.s. Gov't Biological Markers Erythrocytes Blood Case-control Studies Time Factors Etiology Oxyhemoglobins 2,3-diphosphoglycerate Down-regulation Hypophosphatemia Diagnosis Hydrogen-ion Concentration Acute Kidney Injury Oxygen Adverse Effects Risk Factors Renal Replacement Therapy Discipline Nephrology Metabolism Partial Pressure |
Content Type | Text |
Resource Type | Article |
Subject | Epidemiology Transplantation Nephrology Critical Care and Intensive Care Medicine |
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