背景:高磷血症在慢性肾脏病(CKD)中很常见,与透析患者死亡率较高相关。它对非透析患者的影响,尤其是那些保留肾功能的人,仍然不确定。
方法:使用国家健康和营养调查(2001-2008)的数据进行了前瞻性队列研究。血清磷作为连续变量进行分析,或分为三组:<3.5mg/dL,3.5至<4.5mg/dL,≥4.5mg/dL。Cox比例风险模型用于分析磷与全因和心血管疾病(CVD)死亡率之间的关系。有或没有调整年龄,性别,种族,血红蛋白,估计肾小球滤过率(eGFR),血清白蛋白,血清钙,25(OH)D,肥胖,高血压,糖尿病,和CVD。
结果:总共7694名参与者被纳入分析,代表美国2800万CKD患者。在平均92个月的随访中,观察到2708例全因死亡(包括969例CVD死亡)。磷每增加1mg/dL与13%和24%的全因死亡风险增加相关(危险比[HR],1.13;95CI,1.02-1.24)和CVD死亡率(HR,1.24;95CI,1.07-1.45),分别。与<3.5mg/dL相比,磷≥4.5mg/dL与全因死亡率风险增加28%和57%相关(HR,1.28;95CI,1.05-1.55)和CVD死亡率(HR,1.57;95CI,1.19-2.08),分别。在eGFR<60ml/min/1.73m2的参与者中,磷升高(≥4.5mg/dL)与全因死亡率风险增加显着相关(HR,1.36;95CI,1.07-1.72)。eGFR≥60ml/min/1.73m2组(HR,1.31;95CI,0.86-1.99)。这种相关性在由eGFR水平定义的亚组之间没有显着差异(相互作用的P=0.889)。
结论:在非透析CKD患者中,血清磷高于4.5mg/dL与全因和CVD死亡风险增加28%和57%显著相关,分别。这种关系在eGFR<60ml/min/1.73ml的患者中仍然表现出来。然而,对于eGFR≥60ml/min/1.73m2的人群,需要进一步验证。
BACKGROUND: Hyperphosphatemia is common in chronic kidney disease (CKD), associated with higher mortality in dialysis patients. Its impact in non-dialysis patients, especially those with preserved kidney function, remains uncertain.
METHODS: A prospective cohort study was conducted using data from the National Health and Nutrition Examination Survey (2001-2008). Serum phosphorus was analyzed as a continuous variable, or categorized into three groups: < 3.5 mg/dL, 3.5 to < 4.5 mg/dL, and ≥ 4.5 mg/dL. Cox proportional hazards models were used to analyze the association between phosphorus with all-cause and cardiovascular disease (CVD) mortality, with or without adjustment for age, sex, race, hemoglobin, estimated glomerular filtration rate (eGFR), serum albumin, serum calcium, 25(OH)D, obesity, hypertension, diabetes, and CVD.
RESULTS: A total of 7694 participants were included in the analysis, representing 28 million CKD patients in the United States. During mean 92 months of follow up, 2708 all-cause deaths (including 969 CVD deaths) were observed. Per 1 mg/dL increase in phosphorus was associated with a 13% and 24% increased risk of all-cause mortality (hazard ratio [HR], 1.13; 95%CI, 1.02-1.24) and CVD mortality (HR, 1.24; 95%CI, 1.07-1.45), respectively. Compared with the < 3.5 mg/dL, phosphorus ≥ 4.5 mg/dL was associated with a 28% and 57% increased risk of all-cause mortality (HR, 1.28; 95%CI, 1.05-1.55) and CVD mortality (HR, 1.57; 95CI, 1.19-2.08), respectively. In participants with eGFR < 60 ml/min/1.73m2, elevated phosphorus (≥ 4.5 mg/ dL) were significantly associated with increased risk of all-cause mortality (HR, 1.36; 95%CI, 1.07-1.72). No significant association was observed in eGFR ≥ 60 ml/min/1.73m2 group (HR, 1.31; 95%CI, 0.86-1.99). This correlation does not differ significantly between subgroups defined by eGFR level (P for interaction = 0.889).
CONCLUSIONS: Serum phosphorus above 4.5 mg/dL is significantly associated with a 28% and 57% increased risk of all-cause and CVD death in non-dialysis CKD patients, respectively. This relationship still demonstrated in patients with eGFR < 60 ml/min/1.73m2. However, for population with eGFR ≥ 60 ml/min/1.73m2, further verification is needed.