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Outcomes predicted by phosphorous in chronic kidney disease: a retrospective CKD-inception cohort study

David H Smith1, Eric S Johnson, Micah L Thorp

  • 1Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA. David.H.Smith@kpchr.org

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|August 13, 2009
PubMed

Insights

High phosphorous levels in chronic kidney disease (CKD) patients did not increase mortality but significantly raised the risk of needing renal replacement therapy (RRT). Further trials are needed to confirm if managing phosphorous impacts RRT rates.

Area of Science:

  • Nephrology
  • Endocrinology
  • Public Health

Background:

  • The clinical significance of secondary hyperparathyroidism and its effect on morbidity and mortality in chronic kidney disease (CKD) patients remains incompletely understood.
  • Elevated serum phosphorous is a common complication in CKD, potentially linked to adverse outcomes.

Purpose of the Study:

  • To investigate the association between serum phosphorous levels and clinical outcomes in patients with chronic kidney disease (CKD).
  • To determine if serum phosphorous predicts mortality, cardiovascular events, or the need for renal replacement therapy (RRT) in CKD patients.

Main Methods:

  • A retrospective cohort study utilizing clinical databases from a large health maintenance organization.
  • Identification of a CKD inception cohort (stage 3-5) between 1997-2004, followed for up to 5 years.
  • Survival analysis with time-varying covariates was used to assess the relationship between phosphorous levels and outcomes, adjusting for confounders.

Main Results:

  • In a cohort of 930 CKD patients, serum phosphorous levels did not correlate with overall mortality, cardiovascular mortality, or cardiovascular hospitalizations.
  • A significant positive association was observed between higher phosphorous levels and an increased rate of renal replacement therapy (RRT), independent of renal function.

Conclusions:

  • This study found no evidence that serum phosphorous levels impact mortality in CKD patients.
  • Increased phosphorous levels are significantly associated with a higher likelihood of requiring renal replacement therapy (RRT).
  • The findings suggest that while controlling phosphorous may not reduce RRT risk, further randomized controlled trials are warranted to explore the clinical utility of such interventions.
Abstract

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