Abstract
This study aimed to investigate the risk of acute kidney injury (AKI) in hospitalized patients based on admission serum ionized calcium levels. This is a cohort study of all hospitalized adult patients, from January 2009 to December 2013 at a tertiary referral hospital, who had available serum ionized calcium at the time of admission. We excluded patients who had end-stage kidney disease or AKI at admission. We stratified admission serum ionized calcium into 6 groups; ≤ 4.39, 4.40–4.59, 4.60–4.79, 4.80–4.99, 5.00–5.19, and ≥ 5.20 mg/dL. We used serum creatinine criterion of KDIGO definition for diagnosis of AKI. We performed logistic regression analysis to assess the risk of in-hospital AKI occurrence based on admission serum ionized calcium, using serum ionized calcium of 5.00–5.19 mg/dL as the reference group. We studied a total of 25,844 hospitalized patients. Of these, 3,294 (12.7%) developed AKI in hospital, and 622 (2.4%) had AKI stage 2 or 3. We observed a U-shaped association between admission serum ionized calcium and in-hospital AKI, with nadir in-hospital AKI was in serum ionized calcium of 5.00–5.19 mg/dL. After adjustment for confounders, low serum ionized calcium of 4.40–4.59, ≤ 4.39 mg/dL and elevated serum ionized calcium ≥ 5.20 mg/dL were associated with increased risk of AKI with odds ratio of 1.33 (95% CI 1.14–1.56), 1.45 (95% CI 1.21–1.74), and 1.26 (95% CI 1.04–1.54), respectively. Both hypocalcemia, and hypercalcemia at the time of admission were associated with an increased risk of hospital-acquired AKI.
Highlights
This study aimed to investigate the risk of acute kidney injury (AKI) in hospitalized patients based on admission serum ionized calcium levels
The findings of our study showed an independent association between admission level of serum ionized calcium and the risk of in-hospital AKI with a U-curve association
Ionized calcium ≤ 4.59 mg/dL or ≥ 5.20 mg/dL was significantly associated with higher occurrence of in-hospital AKI
Summary
This study aimed to investigate the risk of acute kidney injury (AKI) in hospitalized patients based on admission serum ionized calcium levels. Previous studies have shown associations between electrolyte disturbances and a higher incidence of AKI among hospitalized patients, an imbalance in total calcium, phosphate, and calcium-phosphorus product[16,17]. These abnormalities seem to directly or indirectly correlate with serum ionized calcium[18]. Our study aimed to assess the association between admission serum ionized calcium and risk of in-hospital AKI among hospitalized patients retrieving data from an electronic medical record system
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