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. 2013 Apr;61(4):555-63.
doi: 10.1053/j.ajkd.2012.11.033. Epub 2012 Dec 20.

Relationships between serum and urine phosphorus with all-cause and cardiovascular mortality: the Osteoporotic Fractures in Men (MrOS) Study

Julie R Dominguez  1 , Bryan Kestenbaum, Michel Chonchol, Geoffrey Block, Gail A Laughlin, Cora E Lewis, Ronit Katz, Elizabeth Barrett-Connor, Steve Cummings, Eric S Orwoll, Joachim H Ix; Osteoporotic Fractures in Men (MrOS) Study Research Group
Collaborators, Affiliations

Relationships between serum and urine phosphorus with all-cause and cardiovascular mortality: the Osteoporotic Fractures in Men (MrOS) Study

Julie R Dominguez et al. Am J Kidney Dis. 2013 Apr.

Abstract

Background: Serum phosphorus is associated with cardiovascular disease (CVD) in the general population, but may not comprehensively reflect phosphorus homeostasis. Whether urine phosphorus-creatinine ratio (a marker of intestinal absorption) or urine fractional excretion of phosphorus (FEPi; a marker of urinary phosphorus handling) is associated with risk of mortality or CVD is uncertain.

Study design: Prospective observational study.

Setting & participants: 1,325 community-dwelling men 65 years or older participating in the MrOS Study.

Predictor: Serum phosphorus, urine phosphorus-creatinine ratio, and FEPi.

Outcomes: All-cause and CVD death.

Results: Mean age was 74 ± 6 (SD) years, estimated glomerular filtration rate was 75 ± 16 mL/min/1.73 m(2), and serum phosphorus level was 3.2 ± 0.4 mg/dL. During a median follow-up of 9.3 years, there were 364 (120 CVD) deaths. After adjustment for demographics, CVD risk factors, and kidney function, the risks of all-cause death in the highest quartiles of serum phosphorus (≥3.6 mg/dL), urine phosphorus-creatinine ratio (≥0.55), and FEPi (≥18%) were 1.63 (95% CI, 1.23-2.17), 1.22 (95% CI, 0.90-1.65), and 0.88 (95% CI, 0.64-1.23), respectively, compared to the lowest quartiles of each. Results were similar for CVD death. Results also were similar in those with estimated glomerular filtration rate ≥60 and <60 mL/min/1.73 m(2).

Limitations: Older all-male cohort. Few had advanced chronic kidney disease. Spot urine specimens were used.

Conclusions: In community-living older men, higher serum phosphorus concentrations are associated with all-cause and CVD death. In contrast, urine phosphorus-creatinine ratio and FEPi are not. These findings do not support using urine phosphorus-creatinine ratio or FEPi as adjuvant measures to predict risk of mortality or CVD in the general population.

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Conflict of interest statement

Disclosure of Potential Conflict of Interest: none

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Annual all-cause mortality rates by serum phosphorus concentration. Error bars represent 95% convifidence intervals. P value for departure from linearity <0.001.
Figure 2
Figure 2
Annual cardiovascular mortality rates by serum phosphorus concentration. Error bars represent 95% convifidence intervals. P value for departure from =0.003).
See this image and copyright information in PMC

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