Hyperphosphatemia in Chronic Kidney Disease: Patient Characteristics and Dialysis Mortality during the First Year of Dialysis

Abstract

Aims: To describe the characteristics of chronic kidney disease patients with hyperphosphatemia before dialysis. To assess the impact of pre-dialysis hyperphosphatemia on dialysis mortality.Methods: All patients beginning a dialysis treatment in [2005][2006] in all the nephrology units operating in the Lorraine region of northeastern France were considered. Among them, those who were referred to a nephrologist more than 1 month before dialysis and had atleast one pre-dialysis phosphatemia measurement were included. All-cause mortality during the first year of dialysis was the outcome of interest and phosphatemia level the parameter of interest.Results: Of 406 patients included (mean age, 68.2 ± 14.8 years), 53% had pre-dialysis hyperphosphatemia, defined by a mean serum phosphate > 1.45 mmol/L during an average pre-dialysis nephrology follow-up period of 10 months. Patients with hyperphosphatemia were younger than those with normophosphatemia, and more often women. They were more likely to have diabetic nephropathy, less likely to have hypertensive nephropathy and cardiovascular comorbidity, and had fewer comorbidities. We found no association between hyperphosphatemia and mortality.Conclusions: This study shows that patients with pre-dialysis hyperphosphatemia differ from those with normophosphatemia. Larger studies are warranted to confirm or refute the absence of a relationship between predialysis hyperphosphatemia and dialysis mortality.

Hyperphosphatemia in End Stage Renal Disease: Prevalence and Patients Characteristics of Multiethnic Population of United Arab Emirates

“…Several studies have reported a correlation between hyperphosphatemia and female gender [23,[26][27], a similar finding was observed in our study as well. The reasons for this association are not clear and may be ascribed to the estrogen-mediated regulation of renal phosphate reabsorption [25,28].…”

“…The inverse association of hyperphosphatemia with hypertensive nephropathy has been reported by a previous study [23]. The mechanisms underlying this association are not known.…”

“…The correlation between hyperphosphatemia and lower age has been reported by many studies conducted in chronic kidney disease as well as dialysis population [6,20,[23][24]. This can be attributed to the reduced dietary phosphate intake and changes in renal phosphate handling with age [25].…”

“…Hyperphosphatemia and its association with higher BMI have been described in dialysis population [5,23,29]. The reason can be attributed to the fact that the major determinants of both the BMI and serum phosphate are the dietary habits and nutritional status.…”

Diabetes Mellitus and Younger Age Are Risk Factors for Hyperphosphatemia in Peritoneal Dialysis Patients

“…Hyperphosphatemia has been described in animal models of diabetes mellitus and in humans with diabetic nephropathy but the mechanism(s) is unclear [ 16 , 17 , 18 ]. It is possible that patients with diabetes mellitus simply eat more phosphate or more bioavailable phosphate.…”