C P Kovesdy1, J E Anderson, K Kalantar-Zadeh. 1. Division of Nephrology, Salem Veterans Affairs Medical Center, 1970 Roanoke Blvd., Salem, VA 24153, USA. csaba.kovesdy@va.gov
Abstract
BACKGROUND/AIMS: Hyperphosphatemia is associated with higher mortality and increased incidence of end-stage renal disease in patients with non-dialysis dependent CKD (NDD-CKD), but there has not been a concomitant assessment of mortality and progressive kidney disease that would also account for cumulative effects of hyperphosphatemia. METHODS: In order to account for the cumulative effects of abnormal serum phosphorus we examined associations of not only baseline, but also time-averaged serum phosphorus levels with all-cause mortality, the composite of mortality or ESRD and the slopes of estimated glomerular filtration rate (eGFR), by using Cox models and mixed effects models in a contemporary cohort of 713 males with moderate and advanced NDD-CKD. RESULTS: Higher baseline and time-averaged serum phosphorus were both associated with mortality and with the composite outcome. A 1 mg/dl higher time-averaged serum phosphorus was associated with a multivariable adjusted hazard ratio of all-cause mortality (95% CI) of 1.56 (1.19 - 2.05), p = 0.001. Higher serum phosphorus was associated with a steeper slope of eGFR in unadjusted analyses, but this association became non-significant after multivariable adjustments. CONCLUSION: The cumulative burden of hyperphosphatemia is associated with increased mortality in patients with moderate and advanced NDD-CKD. Clinical trials are needed to determine if lowering serum phosphorus can result in improved mortality in this population.
BACKGROUND/AIMS: Hyperphosphatemia is associated with higher mortality and increased incidence of end-stage renal disease in patients with non-dialysis dependent CKD (NDD-CKD), but there has not been a concomitant assessment of mortality and progressive kidney disease that would also account for cumulative effects of hyperphosphatemia. METHODS: In order to account for the cumulative effects of abnormal serum phosphorus we examined associations of not only baseline, but also time-averaged serum phosphorus levels with all-cause mortality, the composite of mortality or ESRD and the slopes of estimated glomerular filtration rate (eGFR), by using Cox models and mixed effects models in a contemporary cohort of 713 males with moderate and advanced NDD-CKD. RESULTS: Higher baseline and time-averaged serum phosphorus were both associated with mortality and with the composite outcome. A 1 mg/dl higher time-averaged serum phosphorus was associated with a multivariable adjusted hazard ratio of all-cause mortality (95% CI) of 1.56 (1.19 - 2.05), p = 0.001. Higher serum phosphorus was associated with a steeper slope of eGFR in unadjusted analyses, but this association became non-significant after multivariable adjustments. CONCLUSION: The cumulative burden of hyperphosphatemia is associated with increased mortality in patients with moderate and advanced NDD-CKD. Clinical trials are needed to determine if lowering serum phosphorus can result in improved mortality in this population.
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: Lynn M Taylor; Kamyar Kalantar-Zadeh; Theodore Markewich; Sara Colman; Debbie Benner; John J Sim; Csaba P Kovesdy Journal: J Ren Care Date: 2011-03
Authors: Rajnish Mehrotra; Carmen A Peralta; Shu-Cheng Chen; Suying Li; Michael Sachs; Anuja Shah; Keith Norris; Georges Saab; Adam Whaley-Connell; Bryan Kestenbaum; Peter A McCullough Journal: Kidney Int Date: 2013-04-24 Impact factor: 10.612