Prognostic Significance of Hypophosphatemia in Kidney Transplant Patients: A Systematic Review and Meta‐Analysis
Bibliographic record
Abstract
Hypophosphatemia is a common electrolyte disorder in kidney transplant (KT) patients, occurring in up to 93% of cases.This condition is mediated by persistent hyperparathyroidism and elevated serum fibroblast growth factor-23 (FGF-23) due to long-standing phosphate retention, leading to increased phosphaturia when the kidney's intrinsic ability to handle phosphate normalizes [1].In severe cases, hypophosphatemia can lead to muscle weakness, cardiomyopathy, hemolytic anemia and respiratory failure [1].However, the clinical significance of hypophosphatemia in milder cases is less well-established.Interestingly, some studies have shown that the presence of hypophosphatemia in KT patients indicated a favorable prognosis, including decreased risks of graft failure, mortality and cardiovascular disease (CVD) [2,3].Other studies, however, demonstrated a U-shaped association between serum phosphate levels and adverse outcomes [4,5].Therefore, using systematic review and meta-analysis techniques, we aimed to summarize all available data to investigate the association between hypophosphatemia and various clinical outcomes, including graft failure, all-cause mortality, cardiovascular mortality and CVD.Three investigators (T.S., T.S., C.W.) independently searched publications indexed in PubMed and Embase databases from inception to March 27, 2024.Search terms were based on terms associated with "hypophosphatemia" and "kidney transplant."
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Meta-analysis | low |
| gpt | no category Domain: not available · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Meta-analysis | high |
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 | 0.006 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.020 |
| Bibliometrics | 0.005 | 0.008 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| 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, unvalidatedLabeled directly by 2 models reading the full record.
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".