Association between serum phosphorus and mortality in NHANES 2003–2006: the effect of gender and renal function

Mendonça, Luís; Gonçalves, Francisco Rocha; Sampaio, Susana; Castro-Chaves, Paulo; Pereira, Liliane Desgualdo

doi:10.1007/s40620-021-00969-4

Cited by 4 publications

(7 citation statements)

References 38 publications

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“…Hypocalcaemia is independently associated with CKD, and it tends to predict rapid CKD progression and severe CKD [ 61 , 62 ]. Hyperphosphataemia was significantly associated with CKD progression on univariate analysis but this significance was lost on multivariate analysis; studies have reported that high serum phosphate levels predicted higher rates of CKD progression [ 63 , 64 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hyperuricaemia can also precede the development of CKD, predict incident CKD and is associated [61,62]. Hyperphosphataemia was significantly associated with CKD progression on univariate analysis but this significance was lost on multivariate analysis; studies have reported that high serum phosphate levels predicted higher rates of CKD progression [63,64]. Hyponatraemia was reported in 8.16% of those patients who had CKD progression; CKD progression was 4.5 times more common if a patient had low serum sodium levels.…”

Section: Plos Onementioning

confidence: 99%

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Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Meremo

Paget²,

Duarte³

et al. 2023

PLoS ONE

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Background Chronic kidney disease (CKD) is a major public health issue worldwide and is an important contributor to the overall non-communicable disease burden. Chronic kidney disease is usually asymptomatic, and insidiously and silently progresses to advanced stages in resource limited settings. Methodology A prospective longitudinal study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2022. Demographic and clinical data were extracted from the ongoing continuous clinic records, as well as measurements of vital signs and interviews at baseline and at follow up. Patients provided urine and blood samples for laboratory investigations as standard of care at study entry (0) and at 24 months, and were followed up prospectively for two (2) years. Data were descriptively and inferentially entered into REDcap and analysed using STATA version 17, and multivariable logistic regression analysis was used to identify predictors of CKD progression. Results A total of 312 patients were enrolled into the study, 297 (95.2%) patients completed the study, 10 (3.2%) patients were lost to follow and 5 (1.6%) patients died during the study period. The prevalence of CKD progression was 49.5%, while that of CKD remission was 33% and CKD regression was 17.5%. For patients with CKD progression the median age at baseline was 58 (46–67) years, the median eGFR was 37 (32–51) mL/min/1.73 m2, median urine protein creatinine ratio (uPCR) was 0.038 (0.016–0.82) g/mmol and the median haemoglobin (Hb) was 13.1 (11.7–14.4) g/dl; 95.2% had hypertension, 40.1% patients had diabetes mellitus and 39.5% had both hypertension and diabetes mellitus. Almost half (48.3%) of patients with CKD progression had severely increased proteinuria and 45.6% had anaemia. Variables associated with higher odds for CKD progression after multivariable logistic regression analysis were severely increased proteinuria (OR 32.3, 95% CI 2.8–368.6, P = 0.005), moderately increased proteinuria (OR 23.3, 95% CI 2.6–230.1, P = 0.007), hypocalcaemia (OR 3.8, 95% CI 1.0–14.8, P = 0.047), hyponatraemia (OR 4.5, 95% CI 0.8–23.6, P = 0.042), anaemia (OR 2.1, 95% CI 1.0–4.3, P = 0.048), diabetes mellitus (OR 1.8, 95% CI 0.9–3.6, P = 0.047), elevated HbA1c (OR 1.8, 95% CI 1.2–2.8, P = 0.007) and current smoking (OR 2.8, 95% CI 0.9–8.6, P = 0.049). Conclusion Our study identified a higher prevalence of CKD progression in a prospective longitudinal study of black patients with CKD compared with literature reports. CKD Progression was associated with proteinuria, diabetes mellitus, elevated HbA1c, anaemia, hypocalcaemia, hyponatraemia and current smoking in a cohort of black patients with CKD who had controlled hypertension and diabetes mellitus at baseline.

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Section: Discussionmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Meremo

Paget²,

Duarte³

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

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“…For CVDs, eight articles were included [39][40][41][42][43][44][45][46]. Finally, we found 11 articles reporting the relationship A total of seven articles that assessed the relationship between serum phosphate concentrations and cardiovascular mortality were included [22,[34][35][36][37][38][39]. For CVDs, eight articles were included [39][40][41][42][43][44][45][46].…”

Section: Resultsmentioning

confidence: 99%

“…A total of seven articles that assessed the relationship between serum phosphate concentrations and cardiovascular mortality were included [ 22 , 34 , 35 , 36 , 37 , 38 , 39 ]. For CVDs, eight articles were included [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ].…”

Section: Resultsmentioning

confidence: 99%

High Serum Phosphate Is Associated with Cardiovascular Mortality and Subclinical Coronary Atherosclerosis: Systematic Review and Meta-Analysis

Torrijo-Belanche,

Moreno-Franco,

Muñoz-Cabrejas

et al. 2024

Nutrients

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(1) Background: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. The aim of the study was to examine the existing published results of the association between elevated serum phosphate concentrations and cardiovascular mortality, along with the CVD incidence and subclinical coronary atherosclerosis, in primary prevention among non-selected samples of the general population. (2) Methods: A systematic review and meta-analysis were carried out using literature obtained from PubMed, SCOPUS, and the Web Of Science until March 2024 and following the PRISMA guidelines. Relevant information was extracted and presented. Random and fixed effects models were used to estimate the pooled odds ratio (OR) and hazard ratio (HR) with their 95% coefficient interval (CI), and I2 was used to assess heterogeneity. (3) Results: Twenty-five studies met our inclusion criteria and were included in the meta-analysis (11 cross-sectional and 14 cohort studies). For cardiovascular mortality, which included 7 cohort studies and 41,764 adults, the pooled HR was 1.44 (95% CIs 1.28, 1.61; I2 0%) when the highest versus the reference level of serum phosphate concentrations were compared. For CVDs, which included 8 cohort studies and 61,723 adults, the pooled HR was 1.12 (95% CIs 0.99, 1.27; I2 51%). For subclinical coronary atherosclerosis, which included 11 cross-sectional studies and 24,820 adults, the pooled OR was 1.44 (95% CIs 1.15, 1.79; I2 88%). (4) Conclusions: The highest serum phosphate concentrations were positively associated with a 44% increased risk of cardiovascular mortality and subclinical coronary atherosclerosis.

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“…Hypocalcaemia is independently associated with CKD, and it tends to predict rapid CKD progression and severe CKD (56,57). Hyperphosphataemia was significantly associated with CKD progression on univariate analysis but this significance was lost on multivariate analysis; studies have reported that high serum phosphate levels predicted higher rates of CKD progression (58,59). Hyponatraemia was reported in 8.16 % of those patients who had CKD progression; CKD progression was 4.5 times more common if a patient had low serum sodium levels.…”

Section: Discussionmentioning

confidence: 99%

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Meremo

Paget

Duarte

et al. 2022

Preprint

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Background: Chronic kidney disease (CKD) is a major public health issue worldwide and is an important contributor to the overall non-communicable disease burden. Chronic kidney disease is usually asymptomatic, and insidiously and silently progresses to advanced stages in resource limited settings. Methodology: A prospective longitudinal study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2022. Demographic and clinical data were extracted from the ongoing continuous clinic records, as well as measurements of vital signs and interviews at baseline and at follow up. Patients provided urine and blood samples for laboratory investigations as standard of care at study entry (0) and at 24 months, and were followed up prospectively for two (2) years. Data were descriptively and inferentially entered into REDcap and analysed using STATA version 17, and multivariable logistic regression analysis was used to identify predictors of CKD progression. Results: A total of 312 patients were enrolled into the study, 297 (95.2%) patients completed the study, 10 (3.2%) patients were lost to follow and 5 (1.6%) patients died during the study period. The prevalence of CKD progression was 49.5%, while that of CKD remission was 33% and CKD regression was 17.5%. For patients with CKD progression the median age at baseline was 58 (46 - 67) years, the median eGFR was 37 (32 -51) mL/min/1.73 m2, median urine protein creatinine ratio (uPCR) was 0.038 (0.016 -0.82) g/mmol and the median haemoglobin (Hb) was 13.1 (11.7 – 14.4) g/dl; 95.2% had hypertension, 40.1% patients had diabetes mellitus and 39.5% had both hypertension and diabetes mellitus. Almost half (48.3%) of patients with CKD progression had severely increased proteinuria and 45.6% had anaemia. Variables associated with higher odds for CKD progression after multivariable logistic regression analysis were severely increased proteinuria (OR 32.3, 95 % CI 2.8 - 368.6, P = 0.005), moderately increased proteinuria (OR 23.3, 95% CI 2.6 - 230.1, P= 0.007), hypocalcaemia (OR 3.8, 95 % CI 1.0 - 14.8, P = 0.047), hyponatraemia (OR 4.5, 95% CI 0.8 - 23.6, P= 0.042), anaemia (OR 2.1, 95% CI 1.0 - 4.3, P= 0.048), diabetes mellitus (OR 1.8, 95 % CI 0.9 - 3.6, P = 0.047), elevated HbA1c (OR 1.8, 95 % CI 1.2 - 2.8, P = 0.007) and current smoking (OR 2.8, 95 % CI 0.9 - 8.6, P = 0.049). Conclusion: Our study identified a higher prevalence of progression of CKD in a prospective longitudinal study of black patients with CKD. Progression of CKD was associated with proteinuria, diabetes mellitus, elevated HbA1c, anaemia, hypocalcaemia, hyponatraemia and current smoking. This is a call for nephrologists and clinicians to be vigilant in identifying CKD patients at risk of CKD progression at early stages as this would allow risk stratification to improve kidney disease outcomes.

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Association between serum phosphorus and mortality in NHANES 2003–2006: the effect of gender and renal function

Cited by 4 publications

References 38 publications

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

High Serum Phosphate Is Associated with Cardiovascular Mortality and Subclinical Coronary Atherosclerosis: Systematic Review and Meta-Analysis

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

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