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. 2011 Apr;6(4):883-91.
doi: 10.2215/CJN.07810910. Epub 2011 Mar 10.

Chronic kidney disease progression and outcome according to serum phosphorus in mild-to-moderate kidney dysfunction

Antonio Bellasi  1 , Marcora Mandreoli, Leopoldo Baldrati, Matteo Corradini, Pierpaolo Di Nicolò, Giulio Malmusi, Antonio Santoro
Affiliations

Chronic kidney disease progression and outcome according to serum phosphorus in mild-to-moderate kidney dysfunction

Antonio Bellasi et al. Clin J Am Soc Nephrol. 2011 Apr.

Abstract

Background and objectives: Several factors might alter serum phosphate homeostasis and induce hyperhosphatemia in patients with chronic kidney disease (CKD) not requiring dialysis. However, whether and to what extent hyperphosphatemia is associated with a poor prognosis in different CKD patient groups remain to be elucidated.

Design, setting, participants & measurements: We utilized the "Prevenzione Insufficienza Renale Progressiva" (PIRP) database, a large project sponsored by the Emilia-Romagna Health Institute. PIRP is a collaborative network of nephrologists and general practitioners located in the Emilia-Romagna region, Italy, aimed at increasing awareness of CKD complications and optimizing CKD patient care. We identified 1716 patients who underwent a GFR and serum phosphorous assessment between 2004 and 2007. We tested whether phosphate levels ≥4.3 mg/dl are associated with the risk of CKD progression or all causes of death.

Results: Older age and male sex were associated with lower phosphate levels. Instead, higher phosphate levels were noted in patients with diabetes. Patients with phosphate levels ≥4.3 mg/dl were at an increased risk of starting dialysis or dying (hazard ratio 2.04; 95% confidence interval [1.44, 2.90]). Notably, subgroup analyses revealed that the magnitude of the risk associated with hyperphosphatemia varied depending on age, sex, diabetes, and different stages of CKD.

Conclusions: These analyses lend support to the hypothesis that phosphorous abnormalities might have a negative effect on the residual renal function and prognosis in different groups of CKD patients. However, the risk associated with hyperphosphatemia might vary in specific CKD patient subgroups.

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Figures

Figure 1.
Figure 1.
(A) Overall likelihood of experiencing the composite end point according to quartile of serum phosphorus. (B) The HR of experiencing the composite end point according to serum phosphorous levels adjusted for age, case mix, hemoglobin, total calcium, uric acid and ACE inhibitors, vitamin D, and calcium salts use. The solid line represents the HR according to serum phosphorous level; the grey area represents the 95% CI.
Figure 2.
Figure 2.
Association between hyperphosphatemia (serum phosphorus ≥4.3 mg/dl) and the composite outcome (death or progression to ESRD) in different CKD-NDD subgroups. Here are depicted the HR associated with hyperphosphatemia compared with the reference group (serum phosphorus ≥3.3 but <3.8 mg/dl) in different stages of CKD, age category, sex, and diabetes status. All results are adjusted for the case mix and hemoglobin, total calcium, uric acid, ACE inhibitors, vitamin D, and calcium salts use.
Figure 3.
Figure 3.
Overall likelihood of progression to end-stage renal disease and dialysis inception according to the serum phosphorous quartile.
Figure 4.
Figure 4.
Overall likelihood of all causes of death according to the serum phosphorous quartile.
See this image and copyright information in PMC

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