title: Serum Phosphorus and Progression of CKD and Mortality: A Meta-analysis of Cohort Studies.
abstract: BACKGROUND
  Recent studies have indicated that phosphorus may play an independent pathogenic role in chronic kidney disease (CKD) progression, but some of those studies were underpowered and yielded inconsistent results.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Non-dialysis-dependent patients with CKD (transplant recipients were excluded).
  
  
  METHODS
  Studies assessing the risk ratio of serum phosphorus level on kidney failure and mortality for non-dialysis-dependent patients with CKD published from January 1950 to June 2014 were included following systematic searching of MEDLINE, EMBASE, and the Cochrane Library.
  
  
  METHODS
  Serum phosphorus level.
  
  
  RESULTS
  Kidney failure, defined as doubled serum creatinine level, 50% decline in estimated glomerular filtration rate, or end-stage kidney disease.
  
  
  RESULTS
  In 12 cohort studies with 25,546 patients, 1,442 (8.8%) developed kidney failure and 3,089 (13.6%) died. Overall, every 1-mg/dL increase in serum phosphorus level was associated independently with increased risk of kidney failure (hazard ratio, 1.36; 95% CI, 1.20-1.55) and mortality (hazard ratio, 1.20; 95% CI, 1.05-1.37).
  
  
  CONCLUSIONS
  Existence of potential residual confounding could not be excluded.
  
  
  CONCLUSIONS
  This meta-analysis suggests an independent association between serum phosphorus level and kidney failure and mortality among non-dialysis-dependent patients with CKD and suggests that large-scale randomized controlled trials should target disordered phosphorus homeostasis in CKD.
authors: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China; Renal Division, Department of Medicine, Guizhou Provincial People's Hospital; Guizhou Provincial Institute of Nephritic & Urinary Disease, Guiyang, Guizhou.
authors: Jingjing
authors: J
authors: Da
authors: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
authors: Xinfang
authors: X
authors: Xie
authors: Division of Nephrology and Hypertension, Department of Medicine, Division of Biostatistics, Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL.
authors: Myles
authors: M
authors: Wolf
authors: Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors: Sinee
authors: S
authors: Disthabanchong
authors: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
authors: Jinwei
authors: J
authors: Wang
authors: Renal Division, Department of Medicine, Guizhou Provincial People's Hospital; Guizhou Provincial Institute of Nephritic & Urinary Disease, Guiyang, Guizhou.
authors: Yan
authors: Y
authors: Zha
authors: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China. Electronic address: jichenglv75@gmail.com.
authors: Jicheng
authors: J
authors: Lv
authors: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China. Electronic address: zhanglx@bjmu.edu.cn.
authors: Luxia
authors: L
authors: Zhang
authors: Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
authors: Haiyan
authors: H
authors: Wang
mesh_terms: D015331:Cohort Studies; D018450:Disease Progression; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality; D010758:Phosphorus / Q000097:blood*; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000401:mortality
chemical_list: D010758:Phosphorus
keywords: Serum phosphorus; chronic kidney disease (CKD); disease progression; disease trajectory; kidney failure; meta-analysis; mortality; non–dialysis-dependent CKD; phosphorus homeostasis; prognosis; renal outcome