Department of Internal Medicine, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Epidemiology, Erasmus MC, 3000 CA, Rotterdam, The Netherlands.
Eur J Epidemiol. 2018 Sep;33(9):859-871. doi: 10.1007/s10654-018-0407-7. Epub 2018 May 15.
Hyperphosphatemia has been associated with increased mortality in chronic kidney disease but the nature of such a relation in the general population is unclear. To investigate the association between phosphate (P) levels and all-cause and cause-specific mortality, we assessed two cohorts from the Rotterdam Study, with follow-up of 14.5 (RS-I) and 10.9 (RS-II) years until January 2012 with availability of fasting phosphate levels. Deaths were classified according to International Classification of Diseases into 7 groups: cardiovascular, cancer, infections, external, dementia, chronic lung diseases and other causes. Sex-stratified Weibull and competing-risks models were adjusted for age, BMI and smoking. Hazard ratios are expressed per 1 mg/dL increase in phosphate levels. The total number of participants included 3731 (RS-I, 2154 women) and 2494 (RS-II, 1361 women) subjects. The main outcome measures were all-cause and cause-specific mortality. A significant positive association was found between phosphate and all-cause mortality in men (pooled HR (95% CI): 1.46 (1.26-1.69)) but not in women (0.90 (0.77-1.05)). In men, higher phosphate increased the risk for cardiovascular mortality (1.66 (1.29-2.14)), other causes (1.67 (1.16-2.40)) and chronic lung disease mortality (1.94 (1.02-3.72)), the latter driven by mortality due to chronic obstructive pulmonary disease (COPD) (4.44 (2.08-9.49)). No relations were found for mortality due to infections, cancer, dementia or external causes. In conclusion, serum P is associated with increased all-cause, cardiovascular and COPD mortality in men but not women. The association with COPD mortality is novel and needs further research on underlying mechanisms.
高磷血症与慢性肾脏病患者的死亡率增加有关，但这种关系在普通人群中尚不清楚。为了研究磷酸盐 (P) 水平与全因和死因特异性死亡率之间的关系，我们评估了来自鹿特丹研究的两个队列，随访时间分别为 14.5 年（RS-I）和 10.9 年（RS-II），直至 2012 年 1 月，可获得空腹磷酸盐水平。死亡根据国际疾病分类分为 7 组：心血管疾病、癌症、感染、外部原因、痴呆、慢性肺部疾病和其他原因。性别分层的威布尔和竞争风险模型调整了年龄、BMI 和吸烟因素。风险比表示为磷酸盐水平每增加 1mg/dL。总共纳入了 3731 名参与者（RS-I，2154 名女性）和 2494 名参与者（RS-II，1361 名女性）。主要结局指标是全因和死因特异性死亡率。研究发现，磷酸盐与男性全因死亡率呈显著正相关（合并 HR（95%CI）：1.46（1.26-1.69）），但与女性无关（0.90（0.77-1.05））。在男性中，较高的磷酸盐水平增加了心血管死亡率（1.66（1.29-2.14））、其他原因死亡率（1.67（1.16-2.40））和慢性肺部疾病死亡率（1.94（1.02-3.72））的风险，后者主要由慢性阻塞性肺疾病（COPD）死亡率（4.44（2.08-9.49））驱动。未发现感染、癌症、痴呆或外部原因导致的死亡率相关关系。总之，血清 P 与男性全因、心血管和 COPD 死亡率增加相关，但与女性无关。与 COPD 死亡率的关系是新的，需要进一步研究其潜在机制。
