Xu Damin, Lv Jicheng, Wang Jinwei, Zhang Luxia, Zhang Hong
Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People's Republic of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, China.
Nephrology (Carlton). 2017 Jan;22(1):43-48. doi: 10.1111/nep.12724.
Studies investigating the association between blood phosphorus and renal outcomes yielded inconsistent results, and studies from Asian population are extremely limited. We initiated the present cohort study, aiming to prospectively examine the association between blood phosphorus and adverse renal outcomes in a prospective chronic kidney disease (CKD) cohort of Chinese patients majorly with glomerulonephritis.
A total of 1430 patients were involved in the study. Linear regression analyses were used to assess the relationship between phosphorus and the slope of estimated glomerular filtration rate (eGFR). Cox regression analyses were used to assess the association between phosphorus and composite outcomes, which were defined as the presence of at least one of: eGFR halving, end stage renal disease, or death.
During follow-up for an average of 41.4 months, 196 patients developed composite outcomes. The time-average plasma phosphorus was independently associated with the slope of eGFR (β = -0.18, 95% CI: -4.42 to -2.19, P < 0.001). Each 1 mg/dL increases of baseline and time-average phosphorus were respectively associated with a 1.33 (95% confidence interval (CI): 1.09-1.63; P = 0.005) and 2.79 (95%CI: 2.21-3.52; P < 0.001) fold higher risk of composite outcomes. Compared with participants in the bottom quartile of time-average phosphorus, those in the top quartile were at increased risk of composite outcomes, with a hazard ratio of 6.52 (95% CI: 3.05-13.90; P < 0.001).
Plasma phosphorus level is an independent risk factor of adverse renal outcomes in Chinese CKD patients majorly with glomerulonephritis. Compared with baseline value, time-average phosphorus has a stronger relationship with renal prognosis.
关于血磷与肾脏结局之间关联的研究结果并不一致，且来自亚洲人群的研究极为有限。我们开展了本队列研究，旨在对以肾小球肾炎为主的中国慢性肾脏病（CKD）患者前瞻性队列中血磷与不良肾脏结局之间的关联进行前瞻性研究。
共有1430名患者参与本研究。采用线性回归分析评估磷与估算肾小球滤过率（eGFR）斜率之间的关系。采用Cox回归分析评估磷与复合结局之间的关联，复合结局定义为出现以下至少一项：eGFR减半、终末期肾病或死亡。
在平均41.4个月的随访期间，196名患者出现了复合结局。时间平均血浆磷与eGFR斜率独立相关（β = -0.18，95%置信区间（CI）：-4.42至-2.19，P < 0.001）。基线磷和时间平均磷每升高1mg/dL分别与复合结局风险升高1.33倍（95%置信区间（CI）：1.09 - 1.63；P = 0.005）和2.79倍（95%CI：2.21 - 3.52；P < 0.001）相关。与时间平均磷处于最低四分位数的参与者相比，处于最高四分位数的参与者出现复合结局的风险增加，风险比为6.52（95%CI：3.05 - 13.90；P < 0.001）。
血浆磷水平是以肾小球肾炎为主的中国CKD患者不良肾脏结局的独立危险因素。与基线值相比，时间平均磷与肾脏预后的关系更强。
