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Am J Kidney Dis. 2015 Aug;66(2):258-65. doi: 10.1053/j.ajkd.2015.01.009. Epub 2015 Mar 21.

Serum Phosphorus and Progression of CKD and Mortality: A Meta-analysis of Cohort Studies.

Author information

1
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.
2
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.
3
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.
4
Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
5
Renal Division, Department of Medicine, Guizhou Provincial People's Hospital; Guizhou Provincial Institute of Nephritic & Urinary Disease, Guiyang, Guizhou.
6
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.
7
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.

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.

STUDY DESIGN:

Systematic review and meta-analysis.

SETTING & POPULATION:

Non-dialysis-dependent patients with CKD (transplant recipients were excluded).

SELECTION CRITERIA FOR STUDIES:

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.

PREDICTOR:

Serum phosphorus level.

OUTCOME:

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).

LIMITATIONS:

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.

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

PMID:
25804679
DOI:
10.1053/j.ajkd.2015.01.009
[Indexed for MEDLINE]

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