Association between Serum Inorganic Phosphorus Levels and Adverse Outcomes in Chronic Kidney Disease: The Fukushima CKD Cohort Study
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- Oda Akira
- Department of Nephrology and Hypertension, Fukushima Medical University, Japan
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- Tanaka Kenichi
- Department of Nephrology and Hypertension, Fukushima Medical University, Japan Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Japan
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- Saito Hirotaka
- Department of Nephrology and Hypertension, Fukushima Medical University, Japan
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- Iwasaki Tsuyoshi
- Department of Nephrology and Hypertension, Fukushima Medical University, Japan
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- Watanabe Shuhei
- Department of Nephrology and Hypertension, Fukushima Medical University, Japan
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- Kimura Hiroshi
- Department of Nephrology and Hypertension, Fukushima Medical University, Japan
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- Kazama Sakumi
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Japan
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- Shimabukuro Michio
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Japan Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Japan
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- Asahi Koichi
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Japan Division of Nephrology and Hypertension, Iwate Medical University, Japan
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- Watanabe Tsuyoshi
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Japan
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- Kazama Junichiro James
- Department of Nephrology and Hypertension, Fukushima Medical University, Japan Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Japan
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Abstract
<p>Objective Although an association between serum inorganic phosphorus levels and a poor prognosis has been noted in dialysis patients, these associations have been insufficiently reported in non-dialysis-dependent chronic kidney disease (NDD-CKD) patients. This study attempted to determine the association between serum inorganic phosphorus levels and adverse outcomes in Japanese NDD-CKD patients. </p><p>Methods We investigated the relationships between serum inorganic phosphorus levels and adverse outcomes, such as kidney events, cardiovascular events, and all-cause death, in Japanese NDD-CKD patients using longitudinal data from the Fukushima CKD Cohort Study with a median follow-up period of 2.8 years. The study evaluated 822 patients with NDD-CKD enrolled between June 2012 and July 2014. A kidney event was defined as a combination of doubling of the baseline serum creatinine or end-stage renal disease. Cox regression was performed to analyze the relationships of the quartile of the serum inorganic phosphorus with kidney events, cardiovascular events, and all-cause death. </p><p>Results The frequency of kidney events per 1,000 person-years exhibited a U-shaped distribution based on serum inorganic phosphorus levels, with these levels not significantly associated with an increased risk of cardiovascular events and all-cause death. A multivariable Cox regression analysis showed an increased risk of kidney events for the highest quartile of the serum inorganic phosphorus levels (≥3.7 mg/dL) versus the second quartile (2.9-3.2 mg/dL, hazard ratio, 3.30; 95% confidence interval, 1.50-7.28; p=0.003). There were no significant associations between the serum calcium levels and adverse outcomes. </p><p>Conclusion Serum inorganic phosphorus levels were associated with an increased risk of CKD progression in Japanese NDD-CKD patients. </p>
Journal
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- Internal Medicine
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Internal Medicine 61 (11), 1653-1662, 2022-06-01
The Japanese Society of Internal Medicine