医学
肾脏疾病
内科学
四分位数
比例危险模型
前瞻性队列研究
人口
磷酸盐
透析
肾病科
肾功能
高磷血症
置信区间
环境卫生
有机化学
化学
作者
Helen Eddington,Richard Hoefield,Smeeta Sinha,Constantina Chrysochou,B. Lane,Robert N. Foley,Janet Hegarty,John P. New,Dónal O’Donoghue,Rachel Middleton,Philip A. Kalra
出处
期刊:Clinical Journal of The American Society of Nephrology
[American Society of Nephrology]
日期:2010-12-01
卷期号:5 (12): 2251-2257
被引量:202
摘要
Higher phosphate is associated with mortality in dialysis patients but few prospective studies assess this in nondialysis patients managed in an outpatient nephrology clinic. This prospective longitudinal study examined whether phosphate level was associated with death in a referred population.Patients (1203) of nondialysis chronic kidney disease (CKD) in the Chronic Renal Insufficiency Standards Implementation Study were assessed. Survival analyses were performed for quartiles of baseline phosphate relative to GFR, 12-month time-averaged phosphate, and baseline phosphate according to published phosphate targets.Mean (SD) eGFR was 32 (15) ml/min per 1.73 m(2), age 64 (14) years, and phosphate 1.2 (0.30) mmol/L. Cox multivariate adjusted regression in CKD stages 3 to 4 patients showed an increased risk of all-cause and cardiovascular mortality in the highest quartile compared with that in the lowest quartile of phosphate. No association was found in CKD stage 5 patients. Patients who had values above recommended targets for phosphate control had increased risk of all-cause and cardiovascular death compared with patients below target. The highest quartile compared with the lowest quartile of 12-month time-averaged phosphate was associated with an increased risk of mortality.In CKD stages 3 to 4 patients, higher phosphate was associated with a stepwise increase in mortality. As phosphate levels below published targets (as opposed to within them) are associated with better survival, guidelines for phosphate in nondialysis CKD patients should be re-examined. Intervention trials are required to determine whether lowering phosphate will improve survival.
科研通智能强力驱动
Strongly Powered by AbleSci AI