title: Serum phosphate measured at 6 and 12 months after successful kidney transplant is independently associated with subsequent graft loss.
abstract: OBJECTIVE
  Serum phosphate concentrations have been shown to predict graft loss in prevalent, but not incident, kidney transplant populations. The reasons for this are unknown. We investigated whether serum phosphate at 6 or 12 months posttransplant was associated with graft loss in the same cohort.
  
  
  METHODS
  Data were collected for 325 patients transplanted and followed up at a single center (1996-2004). The association between serum phosphate at 6 and 12 months posttransplant and graft failure was analyzed.
  
  
  RESULTS
  Univariable associations with death-censored graft failure were seen for serum phosphate at 6 and 12 months (hazard ratio [HR] 1.33; 95% confidence interval [CI] 1.20-1.48; P < .001, and HR 1.40; CI 1.27-1.54; P < .001). On bivariable analysis (phosphate at 6 vs 12 mo), a significant association remained for both variables and increased graft failure rate (HR 1.19; CI 1.07-1.34; P = .002, and HR 1.37; CI 1.21-1.55; P < .001). These associations persisted in multivariable models (HR 1.27; CI 1.07-1.51; P = .007, and HR 1.34; CI 1.14-1.57; P < .001 for phosphate at 6 and 12 mo).
  
  
  CONCLUSIONS
  Serum phosphate at 6 and 12 months posttransplant is an independent predictor of graft loss. Any future trial designed to investigate the benefits of phosphate lowering should consider recruiting patients as early as 6 months posttransplant.
authors.affiliation: Renal Unit, Queen Elizabeth Hospital, Birmingham, B15 2TH, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Benavente
authors.forename: Colin D
authors.initials: CD
authors.lastname: Chue
authors.forename: Jason
authors.initials: J
authors.lastname: Moore
authors.forename: Clara
authors.initials: C
authors.lastname: Addison
authors.forename: Richard
authors.initials: R
authors.lastname: Borrows
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Ferro
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000401:mortality*; D017674:Hypophosphatemia / Q000097:blood / Q000401:mortality*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality*; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D010710:Phosphates