Incidence of Hypophosphatemia and Clinical Outcomes in Patients Exposed to Kidney Replacement Therapy: A Post Hoc Analysis of the STARRT-AKI Trial
Bibliographic record
Abstract
Background: Patients receiving renal replacement therapy (RRT) are at increased risk of hypophosphatemia, which can predispose to functional muscle weakness and prolonged respiratory failure. The impact of hypophosphatemia on clinical outcomes in patients receiving RRT has been described in small retrospective studies, yet has not been evaluated in a contemporary, large prospective study. We conducted a secondary analysis of the STARRT-AKI trial to identify clinical parameters associated with incident hypophosphatemia during RRT and to examine the association of hypophosphatemia with clinical outcomes. Methods: This was a post hoc study of the STARRT-AKI trial, a multinational RCT comparing 2 RRT initiation strategies in critically ill adult patients with AKI. Eligibility for this analysis included 1) receipt of RRT, 2) CRRT >24 hours or IHD/SLED >1 session, 3) normal serum phosphate on the day of RRT initiation, and 4) >1 serum phosphate measurement during RRT. A truncated hurdle model was built to determine which baseline characteristics were associated with any hypophosphatemia (<0.7 mmol/L) and severe hypophosphatemia (<0.5 mmol/L). The primary outcome of ventilator-free days (VFD) at 28 days was assessed with an inverse probability weighted zero-inflated negative binomial model and a win-ratio analysis (mortality as first hierarchy). Secondary outcomes of RRT dependence and mortality at 90 days were assessed with logistic regression. Results: Of 1,940 patients included, hypophosphatemia occurred in 33%. Male sex, higher weight, standard-strategy arm, and higher baseline phosphate were associated with the occurrence of hypophosphatemia during RRT. Duration of hypophosphatemia was associated with lower first-day serum phosphate and the use of CRRT. Patients without severe hypophosphatemia during RRT had more VFD at 28 days (β 1.16 [95% CI 1.06- 1.27], p<0.001. A similar trend of VFD was found among those without any hypophosphatemia during RRT (β 1.06 [95% CI 1.0 - 1.1], p=0.05. These associations were consistent in the win-ratio analysis. There was no association between incident hypophosphatemia and RRT dependence or mortality at 90 days. Conclusion: Among patients in the STARRT-AKI trial who received RRT, incident hypophosphatemia following RRT initiation was associated with fewer ventilator-free days.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.009 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".