BACKGROUND AND OBJECTIVES: Hypophosphatemia is common in the first year after kidney transplantation, but its clinical implications are unclear. We investigated the relationship between the severity of post-transplant hypophosphatemia and mortality or death-censored graft failure in a large cohort of renal transplant recipients with long-term follow-up. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a longitudinal cohort study in 957 renal transplant recipients who were transplanted between 1993 and 2008 at a single center. We used a large real-life dataset containing 28,178 phosphate measurements (median of 27; first to third quartiles, 23-34) serial measurements per patient) and selected the lowest intraindividual phosphate level during the first year after transplantation. The primary outcomes were all-cause mortality, cardiovascular mortality, and death-censored graft failure. RESULTS: The median (interquartile range) intraindividual lowest phosphate level was 1.58 (1.30-1.95) mg/dl, and it was reached at 33 (21-51) days post-transplant. eGFR was the main correlate of the lowest serum phosphate level (model R2 =0.32). During 9 (5-12) years of follow-up, 181 (19%) patients developed graft failure, and 295 (35%) patients died, of which 94 (32%) deaths were due to cardiovascular disease. In multivariable Cox regression analysis, more severe hypophosphatemia was associated with a lower risk of death-censored graft failure (fully adjusted hazard ratio, 0.61; 95% confidence interval, 0.43 to 0.88 per 1 mg/dl lower serum phosphate) and cardiovascular mortality (fully adjusted hazard ratio, 0.37; 95% confidence interval, 0.22 to 0.62) but not noncardiovascular mortality (fully adjusted hazard ratio, 1.33; 95% confidence interval, 0.9 to 1.96) or all-cause mortality (fully adjusted hazard ratio, 1.15; 95% confidence interval, 0.81 to 1.61). CONCLUSIONS: Post-transplant hypophosphatemia develops early after transplantation. These data connect post-transplant hypophosphatemia with favorable long-term graft and patient outcomes.
BACKGROUND AND OBJECTIVES:Hypophosphatemia is common in the first year after kidney transplantation, but its clinical implications are unclear. We investigated the relationship between the severity of post-transplant hypophosphatemia and mortality or death-censored graft failure in a large cohort of renal transplant recipients with long-term follow-up. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a longitudinal cohort study in 957 renal transplant recipients who were transplanted between 1993 and 2008 at a single center. We used a large real-life dataset containing 28,178 phosphate measurements (median of 27; first to third quartiles, 23-34) serial measurements per patient) and selected the lowest intraindividual phosphate level during the first year after transplantation. The primary outcomes were all-cause mortality, cardiovascular mortality, and death-censored graft failure. RESULTS: The median (interquartile range) intraindividual lowest phosphate level was 1.58 (1.30-1.95) mg/dl, and it was reached at 33 (21-51) days post-transplant. eGFR was the main correlate of the lowest serum phosphate level (model R2 =0.32). During 9 (5-12) years of follow-up, 181 (19%) patients developed graft failure, and 295 (35%) patients died, of which 94 (32%) deaths were due to cardiovascular disease. In multivariable Cox regression analysis, more severe hypophosphatemia was associated with a lower risk of death-censored graft failure (fully adjusted hazard ratio, 0.61; 95% confidence interval, 0.43 to 0.88 per 1 mg/dl lower serum phosphate) and cardiovascular mortality (fully adjusted hazard ratio, 0.37; 95% confidence interval, 0.22 to 0.62) but not noncardiovascular mortality (fully adjusted hazard ratio, 1.33; 95% confidence interval, 0.9 to 1.96) or all-cause mortality (fully adjusted hazard ratio, 1.15; 95% confidence interval, 0.81 to 1.61). CONCLUSIONS: Post-transplant hypophosphatemia develops early after transplantation. These data connect post-transplant hypophosphatemia with favorable long-term graft and patient outcomes.
Authors: David Benavente; Colin D Chue; Jason Moore; Clara Addison; Richard Borrows; Charles J Ferro Journal: Exp Clin Transplant Date: 2012-04 Impact factor: 0.945
Authors: Andrea Trombetti; Laura Richert; Karine Hadaya; Jean-Daniel Graf; François R Herrmann; Serge L Ferrari; Pierre-Yves Martin; René Rizzoli Journal: Eur J Endocrinol Date: 2011-02-18 Impact factor: 6.664
Authors: Leandro C Baia; Jelmer K Humalda; Marc G Vervloet; Gerjan Navis; Stephan J L Bakker; Martin H de Borst Journal: Clin J Am Soc Nephrol Date: 2013-08-08 Impact factor: 8.237
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Charat Thongprayoon; Javier A Neyra; Panupong Hansrivijit; Juan Medaura; Napat Leeaphorn; Paul W Davis; Wisit Kaewput; Tarun Bathini; Sohail Abdul Salim; Api Chewcharat; Narothama Reddy Aeddula; Saraschandra Vallabhajosyula; Michael A Mao; Wisit Cheungpasitporn Journal: J Clin Med Date: 2020-06-12 Impact factor: 4.241
Authors: Julio Chevarria; Donal J Sexton; Susan L Murray; Chaudhry E Adeel; Patrick O'Kelly; Yvonne E Williams; Conall M O'Seaghdha; Dilly M Little; Peter J Conlon Journal: Clin Kidney J Date: 2020-05-22