title: Diabetes Mellitus and Younger Age Are Risk Factors for Hyperphosphatemia in Peritoneal Dialysis Patients.
abstract: Hyperphosphatemia has been associated with adverse outcomes in patients with end stage kidney disease (ESKD). The purpose of this study was to determine risk factors for hyperphosphatemia in ESKD patients treated with peritoneal dialysis (PD). This information will be used to develop a patient specific phosphate binder application to facilitate patient self-management of serum phosphate. Adult PD patients documented their food, beverage, and phosphate binder intake for three days using a dietitian developed food journal. Phosphate content of meals was calculated using the ESHA Food Processor SQL Software (ESHA Research, Salem, UT, USA). Clinic biochemistry tests and an adequacy assessment (Baxter Adequest program) were done. Univariate logistic regression was used to determine predictors of serum phosphate >1.78 mmol/L. A multivariable logistic regression model was then fit including those variables that achieved a significance level ofp< 0.20 in univariate analyses. Sixty patients (38 men, 22 women) completed the protocol; they were 60 ± 17 years old, 50% had a history of diabetes mellitus (DM) and 33% had hyperphosphatemia (PO₄ > 1.78 mmol/L). In univariate analysis, the variables associated with an increased risk of hyperphosphatemia with ap-value < 0.2 were male gender (p= 0.13), younger age (0.07), presence of DM (0.005), higher dose of calcium carbonate (0.08), higher parathyroid serum concentration (0.08), lower phosphate intake (0.03), lower measured glomerular filtration rate (0.15), higher phosphate excretion (0.11), and a higher body mass index (0.15). After multivariable logistic regression analysis, younger age (odds ratio (OR) 0.023 per decade, 95% confidence interval (CI) 0.00065 to 0.455;p= 0.012), presence of diabetes (OR 11.40, 95 CI 2.82 to 61.55;p= 0.0003), and measured GFR (OR 0.052 per mL/min decrease; 95% CI 0.0025 to 0.66) were associated with hyperphosphatemia. Our results support that younger age and diabetes mellitus are significant risk factors for hyperphosphatemia. These findings warrant further investigation to determine the potential mechanisms that predispose younger patients and those with DM to hyperphosphatemia.
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada. rimti037@uottawa.ca.
authors.forename: Rameez
authors.initials: R
authors.lastname: Imtiaz
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON K1Y 4E9, Canada. shawken@ohri.ca.
authors.forename: Steven
authors.initials: S
authors.lastname: Hawken
authors.affiliation: Department of Medicine, Division of Nephrology, Ottawa Hospital, University of Ottawa, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, ON K1H 7W9, Canada. bmccormick@toh.on.ca.
authors.forename: Brendan B
authors.initials: BB
authors.lastname: McCormick
authors.affiliation: Ottawa Hospital Academic Family Health Team, Ottawa Hospital, Ottawa, ON K1Y 4K7, Canada. sleung@toh.on.ca.
authors.forename: Simon
authors.initials: S
authors.lastname: Leung
authors.affiliation: Department of Medicine, Division of Nephrology, Ottawa Hospital, University of Ottawa, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, ON K1H 7W9, Canada. shiremath@toh.on.ca.
authors.forename: Swapnil
authors.initials: S
authors.lastname: Hiremath
authors.affiliation: Department of Medicine, Division of Nephrology, Ottawa Hospital, University of Ottawa, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, ON K1H 7W9, Canada. dzimmerman@toh.on.ca.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Zimmerman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002119:Calcium Carbonate / Q000008:administration & dosage; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D004305:Dose-Response Relationship, Drug; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000097:blood; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010710:Phosphates / Q000097:blood; D012307:Risk Factors; D012648:Self Care
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D002119:Calcium Carbonate
keywords: diabetes mellitus; hyperphosphatemia; peritoneal dialysis; phosphate binders