Serum Phosphate and Mortality in Patients with Chronic Kidney Disease
Serum Phosphate and Mortality in Patients with Chronic Kidney Disease
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DOI：
10.2215/cjn.00810110
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发表时间：
2010-12-01
影响因子：
9.8
通讯作者：
Kalra, Philip A.
中科院分区：
文献类型：
--
作者：
Eddington, Helen;Hoefield, Richard;Kalra, Philip A.
背景和目的：高磷酸盐与透析患者的死亡率有关，但很少有前瞻性研究评估在门诊肾病诊所治疗的非透析患者的这一点。设计、设置、参与者和测量：对慢性肾功能不全标准实施研究中的1203例非透析慢性肾脏疾病(CKD)患者进行评估。结果：平均(SD)EGFR为32(15)ml/min/1.73m(2)，年龄为(14)岁，磷酸盐为1.2(0.30)mmol/L。COX多因素调整回归显示，慢性肾脏病3~4期患者全因和心血管死亡的风险最高的四分之一比最低的四分之一高。在CKD分期5的患者中没有发现关联。与低于目标的患者相比，磷酸盐控制的推荐目标值以上的患者全因死亡和心血管死亡的风险增加。与12个月平均磷酸盐的最高四分位数相比，最低四分位数与死亡风险增加有关。结论：在CKD 3-4期患者中，较高的磷酸盐与死亡率的逐步增加有关。由于磷酸盐水平低于公布的目标(而不是在其范围内)与更好的生存相关，应该重新审查非透析CKD患者的磷酸盐指南。需要进行干预试验来确定降低磷酸盐是否会提高存活率。临床肾脏病5：2251-2257,2010。DOI：10.2215/CJN.00810110
Background and objectives: Higher phosphate is associated with mortality in dialysis patients but few prospective studies assess this in nondialysis patients managed in an outpatient nephrology clinic. This prospective longitudinal study examined whether phosphate level was associated with death in a referred population.Design, setting, participants & measurements: Patients (1203) of nondialysis chronic kidney disease (CKD) in the Chronic Renal Insufficiency Standards Implementation Study were assessed. Survival analyses were performed for quartiles of baseline phosphate relative to GFR, 12-month time-averaged phosphate, and baseline phosphate according to published phosphate targets.Results: Mean (SD) eGFR was 32 (15) ml/min per 1.73 m(2), age 64 (14) years, and phosphate 1.2 (0.30) mmol/L. Cox multivariate adjusted regression in CKD stages 3 to 4 patients showed an increased risk of all-cause and cardiovascular mortality in the highest quartile compared with that in the lowest quartile of phosphate. No association was found in CKD stage 5 patients. Patients who had values above recommended targets for phosphate control had increased risk of all-cause and cardiovascular death compared with patients below target. The highest quartile compared with the lowest quartile of 12-month time-averaged phosphate was associated with an increased risk of mortality.Conclusions: In CKD stages 3 to 4 patients, higher phosphate was associated with a stepwise increase in mortality. As phosphate levels below published targets (as opposed to within them) are associated with better survival, guidelines for phosphate in nondialysis CKD patients should be re-examined. Intervention trials are required to determine whether lowering phosphate will improve survival. Clin J Am Soc Nephrol 5: 2251-2257, 2010. doi: 10.2215/CJN.00810110