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J Ren Nutr. 2016 Jan;26(1):10-7. doi: 10.1053/j.jrn.2015.07.001. Epub 2015 Aug 24.

Serum Phosphorus Levels, Race, and Socioeconomic Status in Incident Hemodialysis Patients.

Author information

1
Division of Nephrology, Department of Internal Medicine, Kaiser Permanente, Los Angeles, California. Electronic address: Victoria.a.kumar@kp.org.
2
Division of Nephrology, Department of Internal Medicine, Kaiser Permanente, Los Angeles, California.
3
Division of Nephrology, Department of Internal Medicine, Kaiser Permanente, San Diego, California.
4
Department of Research and Evaluation, Kaiser Permanente, Pasadena, California.

Abstract

OBJECTIVE:

We sought to examine the relationship between race, socioeconomic status, and serum phosphorus levels in patients with end-stage renal disease incident to hemodialysis (HD) at a large, integrated health-care delivery system in Southern California.

DESIGN:

Retrospective cohort study.

SUBJECTS:

A total of 5,778 adult patients who initiated HD at our institution between January 1, 2007 and June 30, 2013.

MAIN OUTCOME MEASURES:

Unadjusted and adjusted time-averaged serum phosphorus levels and actual phosphorus levels over time. Phosphorus levels were also analyzed by repeated measures as a continuous measure and by phosphorus category. Baseline patient covariates included age, self-reported race, gender, cause of end-stage renal disease, and Charlson comorbidity index scores. Education and income level were estimated using geocoded data.

RESULTS:

A total of 68,372 phosphorus levels were available for 4,862 patients. Estimated annual family income fell below $40,001 in 66.1% of African Americans (AAs) and 62.7% of Hispanics compared with 43.5% of Asians and 43.7% of whites, P < .0001. Educational level fell into the highest category for whites (70.8%) compared with AA (44.8%) or Hispanic (30.5%) patients, P < .0001. Adjusted time-averaged phosphorus levels were lower among Hispanics (4.33 mg/dL, 95% confidence interval [CI] 4.27-4.40) compared with Asian (4.54 mg/dL, 95% CI 4.45-4.64, P < .001) and white patients (4.48 mg/dL, 95% CI 4.43-4.54, P < .001) but similar to AA patients. Asian patients experienced a significant increase in phosphorus levels over time (0.11 mg/dL per year, P < .0001). There were no significant effects of race, time, or race by time interactions in the unadjusted and adjusted categorical analyses of phosphorus levels.

CONCLUSIONS:

Our findings suggest that serum phosphorus levels are similar among HD patients, irrespective of race or socioeconomic status.

PMID:
26316276
DOI:
10.1053/j.jrn.2015.07.001
[Indexed for MEDLINE]

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