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. 2019 Sep 18;20(1):362.
doi: 10.1186/s12882-019-1556-y.

Hyperphosphatemia and risks of acute kidney injury, end-stage renal disease, and mortality in hospitalized patients

Hongran Moon  1 , Ho Jun Chin  1   2 , Ki Young Na  1   2 , Kwon Wook Joo  1 , Yon Su Kim  1 , Sejoong Kim  3   4 , Seung Seok Han  5
Affiliations

Hyperphosphatemia and risks of acute kidney injury, end-stage renal disease, and mortality in hospitalized patients

Hongran Moon et al. BMC Nephrol. .

Abstract

Background: Hyperphosphatemia is associated with vascular calcification and bone mineral disorders and is a major concern among patients with chronic kidney disease (CKD). However, the relationship between hyperphosphatemia and renal outcome in non-CKD patients has not been studied. Furthermore, the clinical implications of hyperphosphatemia in relation to the risks of acute kidney injury (AKI), end-stage renal disease (ESRD), and mortality after hospitalization remain unresolved.

Methods: A total of 20,686 patients (aged ≥18 years) admitted to Seoul National University Bundang Hospital from January 2013 to December 2013 were retrospectively reviewed. Patients were divided into quartiles according to serum phosphorus level at the time of admission. The odds ratios (ORs) for AKI and hazard ratios (HRs) for ESRD and all-cause mortality were calculated after adjustment of multiple covariates.

Results: AKI developed in 2319 patients (11.2%), with higher ORs for patients in the third and fourth quartiles (1.4 [1.24-1.68] and 2.8 [2.44-3.22], respectively) compared with the first quartile group. During a median follow-up period of 4.0 years, 183 patients (0.88%) developed ESRD and 3675 patients (17.8%) died. Patients in the fourth quartile had higher risks of ESRD and mortality than patients in the first quartile (HRs, 2.3 [1.46-3.75] and 1.4 [1.22-1.49], respectively). These trends remained consistent in patients with an estimated glomerular filtration rate > 60 ml/min/1.73 m2.

Conclusions: Hyperphosphatemia is related to the risks of AKI, ESRD, and mortality, and it may therefore be necessary to monitor serum phosphorus level in hospitalized patients, irrespective of kidney function.

Keywords: Acute kidney injury; End-stage renal disease; Hyperphosphatemia; Mortality; Phosphorus.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Non-linear relationship between serum phosphorus and predicted probability of acute kidney injury (AKI). Fitted line and 95% confidence intervals indicated as solid and shaded areas, respectively
Fig. 2
Fig. 2
Kaplan–Meier curves for end-stage renal disease (ESRD) according to quartiles of serum phosphorus
Fig. 3
Fig. 3
Kaplan–Meier curves for all-cause mortality according to quartiles of serum phosphorus
See this image and copyright information in PMC

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