title: Association of pretransplant serum phosphorus with posttransplant outcomes.
abstract: OBJECTIVE
  Serum phosphorus levels are associated with mortality, cardiovascular disease, and renal function loss in individuals with and without chronic kidney disease. The association of pretransplant serum phosphorus levels with transplant outcomes is not clear.
  
  
  METHODS
  Data of the Scientific Registry of Transplant Recipients (SRTR) up to June 2007 were linked to the database (2001 through 2006) of one of the U.S.-based large dialysis organizations (DaVita). The selected 9384 primary kidney recipients were divided into five groups according to pretransplant serum phosphorus levels (mg/dl): <3.5, 3.5 to <5.5 (reference group), 5.5 to <7.5, 7.5 to <9.5, and ≥9.5. Unadjusted and multivariate adjusted risks for transplant outcomes were compared.
  
  
  RESULTS
  Patients were 48 ± 14 years old and included 37% women and 27% African Americans. After multivariate adjustment, all-cause and cardiovascular death hazard ratios were 2.44 (95% confidence interval: 1.28 to 4.65) and 3.63 (1.13 to 11.64), respectively, in recipients in the ≥9.5 group; allograft loss hazard ratios were 1.42 (1.04 to 1.95) and 2.36 (1.33 to 4.17) in recipients with 7.5 to >9.5 and ≥9.5, respectively. No significant association with delayed graft function was found.
  
  
  CONCLUSIONS
  Pretransplant phosphorus levels 7.5 to <9.5 mg/dl and ≥9.5 mg/dl were associated with increased risk of functional graft failure and increased risk of all-cause and cardiovascular deaths, respectively, when compared with 3.5 to <5.5 mg/dl. Additional studies are needed to examine whether more aggressive control of pretransplant serum phosphorus may improve posttransplant outcomes.
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90509-2910, USA.
authors.forename: Marcelo S
authors.initials: MS
authors.lastname: Sampaio
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.forename: John J
authors.initials: JJ
authors.lastname: Sim
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnan
authors.forename: Allen R
authors.initials: AR
authors.lastname: Nissenson
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010758:Phosphorus / Q000097:blood*; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States
chemical_list: D015415:Biomarkers; D010758:Phosphorus