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2015 ; 16
(ä): 116
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Urinary phosphorus excretion per creatinine clearance as a prognostic marker for
progression of chronic kidney disease: a retrospective cohort study
#MMPMID26215643
Kawasaki T
; Maeda Y
; Matsuki H
; Matsumoto Y
; Akazawa M
; Kuyama T
BMC Nephrol
2015[Jul]; 16
(ä): 116
PMID26215643
show ga
BACKGROUND: Whether phosphate itself has nephrotoxicity in patients with chronic
kidney disease (CKD) is controversial, although phosphate excretion into urine
may cause tubular damage in rat models. To evaluate actual phosphate load on each
nephron, we examined the association between 24-h urinary phosphorus excretion
per creatinine clearance (24-h U-P/CCr), a newly proposed index that is a
surrogate for nephron load, and CKD progression in patients with CKD. METHODS: We
conducted a single-center, retrospective cohort study. To avoid potential
confounders for protein intake, only patients on our educational program for CKD
with a fixed diet regimen and aged 20 years or older were included. The
observation period was 3 years. Primary outcomes were CKD progression defined as
a composite of end-stage kidney disease (ESKD) or 50 % reduction of estimated
glomerular filtration rate. Patients were stratified by quartiles of 24-h U-P/CCr
levels as Quartiles 1-4. The association was examined in three models: unadjusted
(Model 1), adjusted for risk factors for CKD progression (Model 2), and factors
that affect renal phosphate handling (Model 3). RESULTS: A total of 191 patients
met the eligibility criteria. Patients with higher 24-h U-P/CCr showed a higher
risk for the composite outcomes. The hazard ratios [95 % confidence interval] for
24-h U-P/CCr levels in Quartile 2, 3, and 4, respectively, versus Quartile 1 were
2.56 (1.15-6.24), 7.53 (3.63-17.62), and 12.17 (5.82-28.64) in Model 1; 1.66
(0.63-4.97), 3.57 (1.25-11.71), and 5.34 (1.41-22.32) in Model 2; and 3.07
(0.97-11.85), 7.52 (2.13-32.69), and 7.89 (1.74-44.33) in Model 3. CONCLUSIONS:
Our study showed that higher phosphorus excretion per creatinine clearance was
associated with CKD progression.