Association of hypophosphatemia during continuous kidney replacement therapy and clinical outcomes: a systematic review and meta-analysis.

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 80.30h, 95% CI 31.37-129.22, P =0.001, I2 = 60%). Furthermore, a longer length of ICU stay (WMD 2.76d, 95% CI 2.50-3.02, P <0.00001, I2 = 36%) and CKRT duration (WMD 51.51h, 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.