Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, CA 90502, USA.
Clin J Am Soc Nephrol. 2010 Apr;5(4):683-92. doi: 10.2215/CJN.08601209. Epub 2010 Feb 25.
Epidemiologic studies show an association between higher predialysis serum phosphorus and increased death risk in maintenance hemodialysis (MHD) patients. The hypothesis that higher dietary phosphorus intake and higher phosphorus content per gram of dietary protein intake are each associated with increased mortality in MHD patients was examined.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Food frequency questionnaires were used to conduct a cohort study to examine the survival predictability of dietary phosphorus and the ratio of phosphorus to protein intake. At the start of the cohort, Cox proportional hazard regression was used in 224 MHD patients, who were followed for up to 5 years (2001 to 2006).
Both higher dietary phosphorus intake and a higher dietary phosphorus to protein ratio were associated with significantly increased death hazard ratios (HR) in the unadjusted models and after incremental adjustments for case-mix, diet, serum phosphorus, malnutrition-inflammation complex syndrome, and inflammatory markers. The HR of the highest (compared with lowest) dietary phosphorus intake tertile in the fully adjusted model was 2.37. Across categories of dietary phosphorus to protein ratios of <12, 12 to <14, 14 to <16, and > or =16 mg/g, death HRs were 1.13, 1.00 (reference value), 1.80, and 1.99, respectively. Cubic spline models of the survival analyses showed similar incremental associations.
Higher dietary phosphorus intake and higher dietary phosphorus to protein ratios are each associated with increased death risk in MHD patients, even after adjustments for serum phosphorus, phosphate binders and their types, and dietary protein, energy, and potassium intakes.
流行病学研究表明，维持性血液透析（MHD）患者透析前血清磷水平较高与死亡风险增加有关。本研究假设较高的饮食磷摄入量和每克饮食蛋白质摄入的磷含量与 MHD 患者死亡率增加有关。
设计、地点、参与者和测量方法：使用食物频率问卷进行队列研究，以检查饮食磷和磷与蛋白质摄入比例对患者生存的预测能力。在队列开始时，对 224 名 MHD 患者使用 Cox 比例风险回归进行了随访，随访时间长达 5 年（2001 年至 2006 年）。
在未调整模型和增量调整混杂因素、饮食、血清磷、营养不良-炎症综合征和炎症标志物后，较高的饮食磷摄入量和较高的饮食磷与蛋白质比值均与死亡风险比（HR）显著增加相关。在完全调整模型中，最高（与最低）饮食磷摄入量三分位组的 HR 为 2.37。在饮食磷与蛋白质比值<12、12 至<14、14 至<16 和≥16mg/g 的分类中，死亡 HR 分别为 1.13、1.00（参考值）、1.80 和 1.99。生存分析的三次样条模型显示出类似的增量关联。
即使在调整血清磷、磷结合剂及其类型以及饮食蛋白质、能量和钾摄入量后，较高的饮食磷摄入量和较高的饮食磷与蛋白质比值均与 MHD 患者死亡风险增加相关。
