Department of Nephrology and Hypertension, Fukushima Medical University, Japan.
Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Japan.
Intern Med. 2022 Jun 1;61(11):1653-1662. doi: 10.2169/internalmedicine.7870-21. Epub 2021 Nov 20.
Objective Although an association between serum inorganic phosphorus levels and a poor prognosis has been noted in dialysis patients, these associations have been insufficiently reported in non-dialysis-dependent chronic kidney disease (NDD-CKD) patients. This study attempted to determine the association between serum inorganic phosphorus levels and adverse outcomes in Japanese NDD-CKD patients. Methods We investigated the relationships between serum inorganic phosphorus levels and adverse outcomes, such as kidney events, cardiovascular events, and all-cause death, in Japanese NDD-CKD patients using longitudinal data from the Fukushima CKD Cohort Study with a median follow-up period of 2.8 years. The study evaluated 822 patients with NDD-CKD enrolled between June 2012 and July 2014. A kidney event was defined as a combination of doubling of the baseline serum creatinine or end-stage renal disease. Cox regression was performed to analyze the relationships of the quartile of the serum inorganic phosphorus with kidney events, cardiovascular events, and all-cause death. Results The frequency of kidney events per 1,000 person-years exhibited a U-shaped distribution based on serum inorganic phosphorus levels, with these levels not significantly associated with an increased risk of cardiovascular events and all-cause death. A multivariable Cox regression analysis showed an increased risk of kidney events for the highest quartile of the serum inorganic phosphorus levels (≥3.7 mg/dL) versus the second quartile (2.9-3.2 mg/dL, hazard ratio, 3.30; 95% confidence interval, 1.50-7.28; p=0.003). There were no significant associations between the serum calcium levels and adverse outcomes. Conclusion Serum inorganic phosphorus levels were associated with an increased risk of CKD progression in Japanese NDD-CKD patients.
尽管已有研究表明透析患者的血清无机磷水平与预后不良相关，但在非透析依赖性慢性肾脏病（NDD-CKD）患者中，相关研究报道尚不足。本研究旨在探讨日本 NDD-CKD 患者血清无机磷水平与不良结局之间的关系。
我们利用福岛慢性肾脏病队列研究的纵向数据（中位随访时间 2.8 年），调查了血清无机磷水平与 NDD-CKD 患者不良结局（如肾脏事件、心血管事件和全因死亡）之间的关系。该研究共纳入了 2012 年 6 月至 2014 年 7 月期间入组的 822 例 NDD-CKD 患者。肾脏事件定义为基线血清肌酐加倍或终末期肾病。采用 Cox 回归分析血清无机磷四分位与肾脏事件、心血管事件和全因死亡的关系。
基于血清无机磷水平，肾脏事件的发生率呈 U 型分布，且该水平与心血管事件和全因死亡风险的增加无显著相关性。多变量 Cox 回归分析显示，血清无机磷水平最高四分位数（≥3.7mg/dL）与第二四分位数（2.9-3.2mg/dL）相比，肾脏事件风险增加（危险比，3.30；95%置信区间，1.50-7.28；p=0.003）。血清钙水平与不良结局之间无显著关联。
血清无机磷水平与日本 NDD-CKD 患者的 CKD 进展风险增加相关。
