• Marine Saour, Norddine Zeroual, Jérôme Ridolfo, Erika Nogue, Marie-Christine Picot, Philippe Gaudard, and Pascal H Colson.
• Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France. Electronic address: m-saour@chu-montpellier.fr.
• J. Cardiothorac. Vasc. Anesth. 2020 Nov 1; 34 (11): 2964-2972.

ObjectiveAcute kidney injury (AKI) is a common complication after cardiac surgery and may affect prognosis. Serum phosphate (SPh) elevation is well-known to occur after AKI but not well-documented. The aim of the present study was to describe SPh changes during AKI after cardiac surgery and to assess the accuracy for the diagnosis of AKI severity and recovery.DesignProspective, single center, observational study.SettingIntensive care unit of a tertiary university hospital.ParticipantsAll patients admitted consecutively to the intensive care unit between February 2015 and March 2016.Measurements And Main ResultsAKI was defined according to Kidney Disease Improving Global Outcomes criteria and classified as nonsevere (stage 1) and severe (stages 2 and 3). Receiver operating characteristic curve analysis was conducted to test reliability of SPh for AKI severity and recovery. AKI occurred in 86 of the 260 patients included (33%) in the study; 58 (67%) experienced nonsevere AKI, and 28 (33%) experienced severe AKI. A significant elevation of SPh values was observed in AKI patients, which peaked at 48 hours. At this time, an SPh of 1.33 mmol/L demonstrated a good accuracy for AKI severity, with an area under the curve of 0.91 (95% confidence interval 0.82-1.00). For kidney recovery, a 25% SPh decrease 24 hours after the peak had a positive predictive value of 100%, and a 2.5% decrease allowed for the reclassification of patients when the serum creatinine had not decreased enough.ConclusionsThe results showed that SPh changes closely follow AKI severity and kidney recovery after cardiac surgery. In addition to serum creatinine, this simple biological marker may help predict early favorable outcome.Copyright © 2020 Elsevier Inc. All rights reserved.

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