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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 PLoS+One
2016 ; 11
(4
): e0154469
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English Wikipedia
The Impact of Normal Range of Serum Phosphorus on the Incidence of End-Stage
Renal Disease by A Propensity Score Analysis
#MMPMID27123981
Chang WX
; Xu N
; Kumagai T
; Shiraishi T
; Kikuyama T
; Omizo H
; Sakai K
; Arai S
; Tamura Y
; Ota T
; Shibata S
; Fujigaki Y
; Shen ZY
; Uchida S
PLoS One
2016[]; 11
(4
): e0154469
PMID27123981
show ga
BACKGROUND: Although hyperphosphatemia is deemed a risk factor of the progression
of chronic kidney disease (CKD), it remains unclear whether the normal range of
serum phosphorus likewise deteriorates CKD. A propensity score analysis was
applied to examine the causal effect of the normal range of serum phosphorus on
the incidence of end-stage renal disease (ESRD). METHODS: A retrospective CKD
cohort of 803 participants in a single institution was analyzed. Propensity score
was estimated using 22 baseline covariates by multivariate binary logistic
regression for the different thresholds of time-averaged phosphorus (TA-P) in the
normal range of serum phosphorus incremented by 0.1 mg/dL from 3.3 to 4.5 mg/dL.
RESULTS: The incidence rate of ESRD was 33.9 per 1,000 person-years over median
follow-up of 4.3 years. Total patients showed the mean baseline phosphorus of
3.37 mg/dL and were divided to quartile. The higher quartile was associated with
the parameters consistent with the advancement of CKD. A stratified Cox
regression showed the highest hazard ratio (HR) at TA-P 3.4 mg/dL (HR 17.60, 95%
CI 3.92-78.98) adjusted for baseline covariates such as sex, age, diabetic
nephropathy, estimated GFR, serum albumin, Na-Cl, phosphorus, LDL-C and
proteinuria. Adjusted HRs remained high up to TA-P 4.2 mg/dL (HR 2.22, 95% CI
1.33-3.71). After propensity score matching conducted at the thresholds of TA-P
3.4, 3.6, 3.8 and 4.0 mg/dL, the higher levels of TA-P showed the higher HRs by
Kaplan-Meier analysis (p < 0.05 by stratified log-rank test). The numbers needed
to treat were calculated as 3.9 to 5.3 over 5 years. CONCLUSIONS: The propensity
score analysis shows that even the normal range of serum phosphorus clearly
accelerates CKD progression to ESRD. Our results encourage clinicians to target
serum phosphorus to inhibit CKD progression in the manner of 'the lower the
better.'