BACKGROUND: High serum phosphate has been identified as an important contributor to the vascular calcification seen in patients with chronic kidney disease (Block et al., Am J Kidney Dis 1998; 31: 607). In patients on hemodialysis, elevated serum phosphate levels are an independent predictor of mortality (Block et al., Am J Kidney Dis 1998; 31: 607; Block, Curr Opin Nephrol Hypertens 2001; 10: 741). The aim of this study was to investigate whether an elevated serum phosphate level was an independent predictor of mortality in patients with a renal transplant. METHODS: Three hundred seventy-nine asymptomatic renal transplant recipients were recruited between June 2000 and December 2002. Serum phosphate was measured at baseline and prospective follow-up data were collected at a median of 2441 days after enrolment. RESULTS: Serum phosphate was significantly higher in those renal transplant recipients who died at follow-up when compared with those who were still alive at follow-up (P<0.001). In Kaplan-Meier analysis, serum phosphate concentration was a significant predictor of mortality (P=0.0001). In multivariate Cox regression analysis, serum phosphate concentration remained a statistically significant predictor of all-cause mortality after adjustment for traditional cardiovascular risk factors, estimated glomerular filtration rate, and high sensitivity C reactive protein (P=0.036) and after adjustment for renal graft failure (P=0.001). CONCLUSIONS: The results of this prospective study are the first to show that a higher serum phosphate is a predictor of mortality in patients with a renal transplant and suggest that serum phosphate provides additional, independent, prognostic information to that provided by traditional risk factors in the risk assessment of patients with a renal transplant.
BACKGROUND: High serum phosphate has been identified as an important contributor to the vascular calcification seen in patients with chronic kidney disease (Block et al., Am J Kidney Dis 1998; 31: 607). In patients on hemodialysis, elevated serum phosphate levels are an independent predictor of mortality (Block et al., Am J Kidney Dis 1998; 31: 607; Block, Curr Opin Nephrol Hypertens 2001; 10: 741). The aim of this study was to investigate whether an elevated serum phosphate level was an independent predictor of mortality in patients with a renal transplant. METHODS: Three hundred seventy-nine asymptomatic renal transplant recipients were recruited between June 2000 and December 2002. Serum phosphate was measured at baseline and prospective follow-up data were collected at a median of 2441 days after enrolment. RESULTS: Serum phosphate was significantly higher in those renal transplant recipients who died at follow-up when compared with those who were still alive at follow-up (P<0.001). In Kaplan-Meier analysis, serum phosphate concentration was a significant predictor of mortality (P=0.0001). In multivariate Cox regression analysis, serum phosphate concentration remained a statistically significant predictor of all-cause mortality after adjustment for traditional cardiovascular risk factors, estimated glomerular filtration rate, and high sensitivity C reactive protein (P=0.036) and after adjustment for renal graft failure (P=0.001). CONCLUSIONS: The results of this prospective study are the first to show that a higher serum phosphate is a predictor of mortality in patients with a renal transplant and suggest that serum phosphate provides additional, independent, prognostic information to that provided by traditional risk factors in the risk assessment of patients with a renal transplant.
Authors: Marcelo S Sampaio; Miklos Z Molnar; Csaba P Kovesdy; Rajnish Mehrotra; Istvan Mucsi; John J Sim; Mahesh Krishnan; Allen R Nissenson; Kamyar Kalantar-Zadeh Journal: Clin J Am Soc Nephrol Date: 2011-09-29 Impact factor: 8.237
Authors: Basma Merhi; Theresa Shireman; Myra A Carpenter; John W Kusek; Paul Jacques; Marc Pfeffer; Madhumathi Rao; Meredith C Foster; S Joseph Kim; Todd E Pesavento; Stephen R Smith; Clifton E Kew; Andrew A House; Reginald Gohh; Daniel E Weiner; Andrew S Levey; Joachim H Ix; Andrew Bostom Journal: Am J Kidney Dis Date: 2017-06-02 Impact factor: 8.860
Authors: Myles Wolf; Miklos Z Molnar; Ansel P Amaral; Maria E Czira; Anna Rudas; Akos Ujszaszi; Istvan Kiss; Laszlo Rosivall; Janos Kosa; Peter Lakatos; Csaba P Kovesdy; Istvan Mucsi Journal: J Am Soc Nephrol Date: 2011-03-24 Impact factor: 10.121
Authors: Zhong Ye; Juan P Palazzo; Liz Lin; Yinzhi Lai; Fran Guiles; Ronald E Myers; Jin Han; Jinliang Xing; Hushan Yang Journal: J Gastroenterol Hepatol Date: 2013-09 Impact factor: 4.029