For critically ill patients on kidney replacement therapy, a common complication may be quietly making recovery harder. A new analysis of data from the STARRT-AKI trial looked at what happens when phosphate levels drop too low during treatment.
Among 1,942 trial participants, 634 developed hypophosphatemia (low phosphate). Those patients had fewer ventilator-free days at 28 days. The effect was even stronger for severe hypophosphatemia. Patients with low phosphate were also 27% less likely to survive and be off the ventilator at 28 days.
However, low phosphate was not linked to higher death rates at 90 days or to long-term kidney dependence. This is an observational analysis, so it cannot prove cause and effect. The findings are limited by potential selection bias and unmeasured factors.
The results suggest that keeping phosphate levels in check during kidney therapy might matter for recovery, but more research is needed to confirm whether treating low phosphate improves outcomes.