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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 Clin+J+Am+Soc+Nephrol
2017 ; 12
(4
): 653-662
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Association of Serum Phosphorus Concentration with Mortality and Graft Failure
among Kidney Transplant Recipients
#MMPMID28159828
Jeon HJ
; Kim YC
; Park S
; Kim CT
; Ha J
; Han DJ
; Oh J
; Lim CS
; Jung IM
; Ahn C
; Kim YS
; Lee JP
; Kim YH
Clin J Am Soc Nephrol
2017[Apr]; 12
(4
): 653-662
PMID28159828
show ga
BACKGROUND AND OBJECTIVES: Hyperphosphatemia in kidney transplant recipients has
been shown to predict poorer graft and patient survival. However, studies
examining hypophosphatemia are scarce. DESIGN, SETTING, PARTICIPANTS, &
MEASUREMENTS: To evaluate the association of serum phosphorus level with patient
and graft survival, we performed a retrospective multicenter cohort study.
Between January of 1997 and August of 2012, 2786 kidney transplant recipients
(41.7±11.4 years; 59.3% men; 73.5% living donors; 26.1% with diabetes; 3.8% with
prior history of cardiovascular disease) were classified into seven groups
according to serum phosphorus levels 1 year after transplantation, with intervals
of 0.5 mg/dl (lowest group, <2.5 mg/dl; highest group, ?5.0 mg/dl; reference
group, 3.5-3.99 mg/dl). Survival analysis was performed by defining baseline time
point as 1 year after transplantation. RESULTS: During median follow-up of 78.5
months, 60 patient deaths and 194 cases of graft loss occurred. In multivariate
analysis, both lowest and highest serum phosphorus groups were associated with
higher mortality, compared with the reference group (hazard ratio [HR], 4.82; 95%
confidence interval [95% CI], 1.36 to 17.02; P=0.01; and HR, 4.24; 95% CI, 1.07
to 16.84; P=0.04, respectively). Higher death-censored graft loss was observed in
the lowest and highest groups (HR, 3.32; 95% CI, 1.42 to 7.79; P=0.01; and HR,
2.93; 95% CI, 1.32 to 6.49; P=0.01, respectively), despite eGFR exhibiting no
difference between the lowest group and reference group (65.4±19.3 versus
61.9±16.7 ml/min per 1.73 m(2); P=0.33). Moreover, serum phosphorus showed a
U-shape association with patient mortality and graft failure in restricted cubic
spline curve analysis. CONCLUSIONS: Serum phosphorus level 1 year after
transplantation exhibits a U-shape association with death-censored graft failure
and patient mortality in kidney transplant patients characterized by relatively
high rate of living donor transplant and low incidence of diabetes and prior
cardiovascular disease compared with Western countries.