title: Serum phosphate and mortality in patients with chronic kidney disease.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Vascular Research Group, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Eddington
authors.forename: Richard
authors.initials: R
authors.lastname: Hoefield
authors.forename: Smeeta
authors.initials: S
authors.lastname: Sinha
authors.forename: Constantina
authors.initials: C
authors.lastname: Chrysochou
authors.forename: Beverley
authors.initials: B
authors.lastname: Lane
authors.forename: Robert N
authors.initials: RN
authors.lastname: Foley
authors.forename: Janet
authors.initials: J
authors.lastname: Hegarty
authors.forename: John
authors.initials: J
authors.lastname: New
authors.forename: Donal J
authors.initials: DJ
authors.lastname: O'Donoghue
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Middleton
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D010710:Phosphates