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Outcomes associated with serum phosphorus level in males with non-dialysis dependent chronic kidney disease

C P Kovesdy1, J E Anderson, K Kalantar-Zadeh

  • 1Division of Nephrology, Salem Veterans Affairs Medical Center, 1970 Roanoke Blvd., Salem, VA 24153, USA. csaba.kovesdy@va.gov

Clinical Nephrology
|April 1, 2010
PubMed

Insights

Elevated serum phosphorus levels in patients with chronic kidney disease (CKD) are linked to higher mortality. This study highlights the cumulative impact of high phosphorus on mortality risk in non-dialysis dependent CKD patients.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Public Health

Background:

  • Hyperphosphatemia is a known risk factor for mortality and end-stage renal disease (ESRD) in non-dialysis dependent chronic kidney disease (NDD-CKD).
  • Previous studies have not fully accounted for the cumulative effects of elevated serum phosphorus over time in NDD-CKD patients.

Purpose of the Study:

  • To investigate the association between cumulative serum phosphorus levels and mortality and kidney function decline in NDD-CKD.
  • To assess the impact of both baseline and time-averaged phosphorus levels on adverse outcomes.

Main Methods:

  • A cohort of 713 males with moderate to advanced NDD-CKD was analyzed.
  • Cox and mixed-effects models were used to examine associations between serum phosphorus (baseline and time-averaged) and outcomes.
  • Outcomes included all-cause mortality, a composite of mortality or ESRD, and the rate of estimated glomerular filtration rate (eGFR) decline.

Main Results:

  • Higher baseline and time-averaged serum phosphorus levels were significantly associated with increased mortality and the composite outcome.
  • A 1 mg/dl increase in time-averaged serum phosphorus correlated with a 1.56-fold increased hazard of all-cause mortality.
  • While unadjusted analyses showed an association between higher phosphorus and faster eGFR decline, this did not remain significant after multivariable adjustments.

Conclusions:

  • The cumulative burden of hyperphosphatemia is a significant predictor of mortality in patients with moderate and advanced NDD-CKD.
  • Further clinical trials are warranted to evaluate the efficacy of serum phosphorus reduction strategies on improving mortality in this patient population.
Abstract

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