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2015 ; 16
(ä): 194
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Serum phosphate and social deprivation independently predict all-cause mortality
in chronic kidney disease
#MMPMID26627078
Solbu MD
; Thomson PC
; Macpherson S
; Findlay MD
; Stevens KK
; Patel RK
; Padmanabhan S
; Jardine AG
; Mark PB
BMC Nephrol
2015[Dec]; 16
(ä): 194
PMID26627078
show ga
BACKGROUND: Hyperphosphataemia is linked to cardiovascular disease and mortality
in chronic kidney disease (CKD). Outcome in CKD is also affected by socioeconomic
status. The objective of this study was to assess the associations between serum
phosphate, multiple deprivation and outcome in CKD patients. METHODS: All adult
patients currently not on renal replacement therapy (RRT), with first time
attendance to the renal outpatient clinics in the Glasgow area between July 2010
and June 2014, were included in this prospective study. Area socioeconomic status
was assessed as quintiles of the Scottish Index of Multiple Deprivation (SIMD).
Outcomes were all-cause and cardiovascular mortality and commencement of RRT.
RESULTS: The cohort included 2950 patients with a median (interquartile range)
age 67.6 (53.6-76.9) years. Median (interquartile range) eGFR was 38.1
(26.3-63.5) ml/min/1.73 m(2), mean (± standard deviation) phosphate was 1.13 (±
0.24) mmol/L and 31.6 % belonged to the most deprived quintile (SIMD quintile I).
During follow-up 375 patients died and 98 commenced RRT. Phosphate ? 1.50 mmol/L
was associated with all-cause (hazard ratio (HR) 2.51; 95 % confidence interval
(CI) 1.63-3.89) and cardiovascular (HR 5.05; 95 % CI 1.90-13.46) mortality when
compared to phosphate 0.90-1.09 mmol/L in multivariable analyses. SIMD quintile I
was independently associated with all-cause mortality. Phosphate did not weaken
the association between deprivation index and mortality, and there was no
interaction between phosphate and SIMD quintiles. Neither phosphate nor SIMD
predicted commencement of RRT. CONCLUSIONS: Multiple deprivation and serum
phosphate were strong, independent predictors of all-cause mortality in CKD and
showed no interaction. Phosphate also predicted cardiovascular mortality. The
results suggest that phosphate lowering should be pursued regardless of
socioeconomic status.