Phosphate — New Marker for RRT Risk Following Trauma

Background: Acute kidney injury (AKI) is a common complication after trauma; however, progression to renal failure requiring renal replacement therapy (RRT) is uncommon (5.1% to 26.0% of ICU admissions) and is associated with high mortality rates (23.8% to 65.8%). Objective: To determine if persistent serum phosphate elevations after trauma reflect impaired renal clearance and predict the need for RRT. Design: Retrospective study. Methods: Review of the trauma registry was conducted at a level 1 trauma center verified by American College of Surgeons from January 1, 2013, to December 31, 2022. Patients with history of chronic kidney disease or end-stage renal disease, admissions lasting ≤72 hours, or patients with isolated burn injuries were excluded. Primary outcome was initiation of RRT within 14 days of admission. Independent predictors of RRT were derived to create the risk-for-renal-replacement-after-trauma (R3T) score. The R3T score was validated with receiver operating characte more...