title: No independent association of serum phosphorus with risk for death or progression to end-stage renal disease in a large screen for chronic kidney disease.
abstract: Whether higher serum phosphorus levels are associated with a higher risk for death and/or progression of chronic kidney disease (CKD) is not well established, and whether the association is confounded by access and barriers to care is unknown. To answer these questions, data of 10,672 individuals identified to have CKD (estimated glomerular filtration rate <60 ml/min per 1.73 m(2)) from those participating in a community-based screening program were analyzed. Over a median follow-up of 2.3 years, there was no association between quartiles of serum phosphorus and all-cause mortality (adjusted hazards ratio for serum phosphorus over 3.3 to 3.7, over 3.7 to 4.1, and over 4.1 mg/dl, respectively: 1.22 (0.95-1.56), 1.00 (0.76-1.32), and 1.00 (0.75-1.33); reference, serum phosphorus of 3.3 mg/dl and below). Individuals in the highest quartile for serum phosphorus had a significantly higher risk for progression to end-stage renal disease (ESRD) (unadjusted hazards ratio, 6.72 (4.16-10.85)); however, the risk became nonsignificant on adjustment for potential confounders. There was no appreciable change in hazards ratio with inclusion of variables related to access and barriers to care. Additional analyses in subgroups based on 12 different variables yielded similar negative associations. Thus, in the largest cohort of individuals with early-stage CKD to date, we could not validate an independent association of serum phosphorus with risk for death or progression to ESRD.
authors.affiliation: Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington, USA.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.forename: Shu-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: Suying
authors.initials: S
authors.lastname: Li
authors.forename: Michael
authors.initials: M
authors.lastname: Sachs
authors.forename: Anuja
authors.initials: A
authors.lastname: Shah
authors.forename: Keith
authors.initials: K
authors.lastname: Norris
authors.forename: Georges
authors.initials: G
authors.lastname: Saab
authors.forename: Adam
authors.initials: A
authors.lastname: Whaley-Connell
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood*; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010758:Phosphorus