NDT Advance Access originally published online on May 21, 2007
Nephrology Dialysis Transplantation 2007 22(10):2909-2916; doi:10.1093/ndt/gfm286
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High plasma phosphate as a risk factor for decline in renal function and mortality in pre-dialysis patients
1Department of Clinical Epidemiology, Leiden University Medical Center, 2Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, 3Department of Nephrology, Leiden University Medical Center, Leiden, 4Hans Mak Institute, Naarden, 5Department of Nephrology, University Medical Center Groningen, Groningen, 6Department of Nephrology, Academic Medical Center, Amsterdam and 7the PREPARE study group consists of: P. Gerlag, Maxima Medical Centre, Veldhoven; C.J. Doorenbos, Deventer Ziekenhuizen, Deventer; K. Jie, Groene Hart Hospital, Gouda; A. Schrander-van der Meer, Rijnland Ziekenhuis, Leiderdorp; C. Verburgh, Kennemer Gasthuis, Haarlem, The Netherlands
Correspondence and offprint requests to: Nora Voormolen, MD, Department of Clinical Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands. Email: e.m.c.voormolen{at}lumc.nl
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Abstract |
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Background. Hyperphosphataemia is associated with increased mortality in patients with chronic kidney disease (CKD) stage IV or on dialysis. Furthermore, in animal studies, elevated plasma phosphate has been shown to be associated with an accelerated decline in renal function. The aim of this study was to determine the association of plasma phosphate with renal function loss and mortality in CKD stage IV–V pre-dialysis patients with GFR <20 ml/min/1.73 m2.
Methods. Incident pre-dialysis patients were included between 1999 and 2001 in the multi-centre PREPARE study, and followed until 2003 or death. Rate of decline in renal function for each patient was calculated by linear regression using the Modification of Diet in Renal Disease (MDRD) formula to estimate GFR (eGFR).
Results. A total of 448 patients were included [mean (SD) age 60 (15) years, eGFR 13 (5.4) ml/min/1.73 m2, decline in renal function 0.38 (0.95) ml/min/month]. Phosphate concentration at baseline was 4.71 (1.16) mg/dl, calcium 9.25 (0.77) mg/dl and calcium–phosphate product 43.5 (10.9) mg2/dl2. For each mg/dl higher phosphate concentration, the mean (95% CI) decline in renal function increased with 0.154 (0.071–0.237) ml/min/month. After adjustment, this association remained [β 0.178 (0.082–0.275)]. Seven percent of the patients died. Crude mortality risk was 1.25 (0.85–1.84) per mg/dl increase in phosphate, which increased to 1.62 (1.02–2.59) after adjustment.
Conclusions. High plasma phosphate is an independent risk factor for a more rapid decline in renal function and a higher mortality during the pre-dialysis phase. Plasma phosphate within the normal range is likely of vital importance in pre-dialysis patients.
Keywords: CKD; decline: mortality; renal function; serum phosphate
Received for publication: 11.12.06
Accepted in revised form: 16. 4.07
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