Serum phosphorus predicts incident chronic kidney disease and end-stage renal disease

Conall M. O'Seaghdha, Shih Jen Hwang, Paul Muntner, Michal L. Melamed, Caroline S. Fox

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background. Elevations in serum phosphorus are associated with renal decline in animal models and progression of established chronic kidney disease (CKD) in human observational studies. We examined whether serum phosphorus levels increase the risk of incident CKD or end-stage renal disease (ESRD) in two population-based prospective cohort studies.Methods. Overall, 2269 participants free of CKD [estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 2] from the Framingham Heart Study (FHS; mean age 42 years; 53% women) and 13372 participants from the Third National Health and Nutrition Examination Survey (NHANES III; mean age 44.3 years, 52% women) contributed to the present study. In the FHS, we evaluated the relationship between baseline phosphorus category (<2.5 mg/dL, 2.5-3.49 mg/dL, 3.5-3.99 mg/dL and ≥4 mg/dL) and incident CKD (n = 267). In NHANES, we examined the relationship between phosphorus below and above 4 mg/dL in relation to incident ESRD (n = 65).Results. FHS participants in the highest phosphorus category had an increased risk of CKD [odds ratio 2.14; 95% confidence interval (CI), 1.07-4.28; P = 0.03] in multivariable-adjusted models when compared to the referent group (2.5-3.49 mg/dL). Similarly, NHANES III participants with phosphorus levels ≥4 mg/dL demonstrated an increased risk of incident ESRD compared to those <4 mg/dL (relative risk 1.90; 95% CI 1.03-3.53; P = 0.04).Conclusions. In prospective studies of the general population, serum phosphorus levels in the upper-normal range were associated with a doubling in the risk of developing incident CKD and ESRD.

Original languageEnglish (US)
Pages (from-to)2885-2890
Number of pages6
JournalNephrology Dialysis Transplantation
Volume26
Issue number9
DOIs
StatePublished - Sep 2011

Fingerprint

Chronic Renal Insufficiency
Phosphorus
Chronic Kidney Failure
Nutrition Surveys
Serum
Prospective Studies
Confidence Intervals
Glomerular Filtration Rate
Population
Observational Studies
Reference Values
Cohort Studies
Animal Models
Odds Ratio
Kidney

Keywords

  • CKD
  • ESRD
  • phosphorus

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Serum phosphorus predicts incident chronic kidney disease and end-stage renal disease. / O'Seaghdha, Conall M.; Hwang, Shih Jen; Muntner, Paul; Melamed, Michal L.; Fox, Caroline S.

In: Nephrology Dialysis Transplantation, Vol. 26, No. 9, 09.2011, p. 2885-2890.

Research output: Contribution to journalArticle

O'Seaghdha, Conall M. ; Hwang, Shih Jen ; Muntner, Paul ; Melamed, Michal L. ; Fox, Caroline S. / Serum phosphorus predicts incident chronic kidney disease and end-stage renal disease. In: Nephrology Dialysis Transplantation. 2011 ; Vol. 26, No. 9. pp. 2885-2890.
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abstract = "Background. Elevations in serum phosphorus are associated with renal decline in animal models and progression of established chronic kidney disease (CKD) in human observational studies. We examined whether serum phosphorus levels increase the risk of incident CKD or end-stage renal disease (ESRD) in two population-based prospective cohort studies.Methods. Overall, 2269 participants free of CKD [estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 2] from the Framingham Heart Study (FHS; mean age 42 years; 53{\%} women) and 13372 participants from the Third National Health and Nutrition Examination Survey (NHANES III; mean age 44.3 years, 52{\%} women) contributed to the present study. In the FHS, we evaluated the relationship between baseline phosphorus category (<2.5 mg/dL, 2.5-3.49 mg/dL, 3.5-3.99 mg/dL and ≥4 mg/dL) and incident CKD (n = 267). In NHANES, we examined the relationship between phosphorus below and above 4 mg/dL in relation to incident ESRD (n = 65).Results. FHS participants in the highest phosphorus category had an increased risk of CKD [odds ratio 2.14; 95{\%} confidence interval (CI), 1.07-4.28; P = 0.03] in multivariable-adjusted models when compared to the referent group (2.5-3.49 mg/dL). Similarly, NHANES III participants with phosphorus levels ≥4 mg/dL demonstrated an increased risk of incident ESRD compared to those <4 mg/dL (relative risk 1.90; 95{\%} CI 1.03-3.53; P = 0.04).Conclusions. In prospective studies of the general population, serum phosphorus levels in the upper-normal range were associated with a doubling in the risk of developing incident CKD and ESRD.",
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AB - Background. Elevations in serum phosphorus are associated with renal decline in animal models and progression of established chronic kidney disease (CKD) in human observational studies. We examined whether serum phosphorus levels increase the risk of incident CKD or end-stage renal disease (ESRD) in two population-based prospective cohort studies.Methods. Overall, 2269 participants free of CKD [estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 2] from the Framingham Heart Study (FHS; mean age 42 years; 53% women) and 13372 participants from the Third National Health and Nutrition Examination Survey (NHANES III; mean age 44.3 years, 52% women) contributed to the present study. In the FHS, we evaluated the relationship between baseline phosphorus category (<2.5 mg/dL, 2.5-3.49 mg/dL, 3.5-3.99 mg/dL and ≥4 mg/dL) and incident CKD (n = 267). In NHANES, we examined the relationship between phosphorus below and above 4 mg/dL in relation to incident ESRD (n = 65).Results. FHS participants in the highest phosphorus category had an increased risk of CKD [odds ratio 2.14; 95% confidence interval (CI), 1.07-4.28; P = 0.03] in multivariable-adjusted models when compared to the referent group (2.5-3.49 mg/dL). Similarly, NHANES III participants with phosphorus levels ≥4 mg/dL demonstrated an increased risk of incident ESRD compared to those <4 mg/dL (relative risk 1.90; 95% CI 1.03-3.53; P = 0.04).Conclusions. In prospective studies of the general population, serum phosphorus levels in the upper-normal range were associated with a doubling in the risk of developing incident CKD and ESRD.

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