Supplementary Material for: 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.

研究背景：低磷血症（hypophosphatemia）是连续性肾脏替代治疗（continuous kidney replacement therapy, CKRT）的常见且可能危及生命的并发症，但目前关于CKRT期间发生低磷血症与患者临床结局之间相关性的研究证据仍较为有限。
研究方法：本研究检索了PubMed、Embase、Web of Science及Cochrane图书馆数据库自建库至2024年3月1日期间的文献，纳入所有探讨以下结局指标的相关研究：全因死亡率、机械通气时长、重症监护病房（intensive care unit, ICU）住院时长及CKRT持续时间。
研究结果：最终共纳入8项队列研究，涉及8631例患者。CKRT期间发生低磷血症与重症患者全因死亡率无统计学相关性（比值比（odds ratio, OR）=0.82，95%置信区间（confidence interval, CI）：0.57~1.18，P=0.28，I²=83%）。然而，低磷血症与更长的机械通气时长相关（加权均数差（weighted mean difference, WMD）=80.30h，95%CI：31.37~129.22，P=0.001，I²=60%）。此外，低磷血症患者的ICU住院时长（WMD=2.76d，95%CI：2.50~3.02，P<0.00001，I²=36%）及CKRT持续时间（WMD=51.51h，95%CI：2.69~100.34，P=0.04，I²=96%）均显著更长。
研究结论：现有证据尚不足以证实CKRT患者的低磷血症与死亡率之间存在相关性。但CKRT期间发生低磷血症可能与重症患者的不良临床结局相关。