Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA.
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Nutrients. 2022 Jul 26;14(15):3070. doi: 10.3390/nu14153070.
(1) Background: Current dietary recommendations for dialysis patients suggest that high phosphorus diets may be associated with adverse outcomes such as hyperphosphatemia and death. However, there has been concern that excess dietary phosphorus restriction may occur at the expense of adequate dietary protein intake in this population. We hypothesized that higher dietary phosphorus intake is associated with higher mortality risk among a diverse cohort of hemodialysis patients. (2) Methods: Among 415 patients from the multi-center prospective Malnutrition, Diet, and Racial Disparities in Kidney Disease Study, we examined the associations of absolute dietary phosphorus intake (mg/day), ascertained by food frequency questionnaires, with all-cause mortality using multivariable Cox models. In the secondary analyses, we also examined the relationship between dietary phosphorus scaled to 1000 kcal of energy intake (mg/kcal) and dietary phosphorus-to-protein ratio (mg/g) with survival. (3) Results: In expanded case-mix + laboratory + nutrition adjusted analyses, the lowest tertile of dietary phosphorus intake was associated with higher mortality risk (ref: highest tertile): adjusted HR (aHR) (95% CI) 3.33 (1.75-6.33). In the analyses of dietary phosphorus scaled to 1000 kcal of energy intake, the lowest tertile of intake was associated with higher mortality risk compared to the highest tertile: aHR (95% CI) 1.74 (1.08, 2.80). Similarly, in analyses examining the association between dietary phosphorus-to-protein ratio, the lowest tertile of intake was associated with higher mortality risk compared to the highest tertile: aHR (95% CI) 1.67 (1.02-2.74). (4) Conclusions: A lower intake of dietary phosphorus was associated with higher mortality risk in a prospective hemodialysis cohort. Further studies are needed to clarify the relationship between specific sources of dietary phosphorus intake and mortality in this population.
(1) 背景：目前针对透析患者的饮食建议表明，高磷饮食可能与高磷血症和死亡等不良后果相关。然而，人们担心在这一人群中，过度限制膳食磷的摄入可能会以牺牲充足的膳食蛋白质摄入为代价。我们假设，在一个多样化的血液透析患者队列中，较高的膳食磷摄入与更高的死亡风险相关。
(2) 方法：在来自多中心前瞻性营养不良、饮食和肾脏疾病种族差异研究的 415 名患者中，我们使用多变量 Cox 模型检查了通过食物频率问卷确定的绝对膳食磷摄入量（mg/天）与全因死亡率之间的关联。在二次分析中，我们还检查了膳食磷与 1000 千卡能量摄入（mg/千卡）的比例和膳食磷与蛋白质比例（mg/g）与生存的关系。
(3) 结果：在扩展的病例组合+实验室+营养调整分析中，最低三分位的膳食磷摄入量与更高的死亡风险相关（参考：最高三分位）：调整后的 HR（aHR）（95%CI）为 3.33（1.75-6.33）。在对膳食磷与 1000 千卡能量摄入进行标准化的分析中，与最高三分位相比，最低三分位的摄入量与更高的死亡风险相关：aHR（95%CI）为 1.74（1.08,2.80）。同样，在分析膳食磷与蛋白质比值的相关性时，最低三分位的摄入量与最高三分位相比，与更高的死亡风险相关：aHR（95%CI）为 1.67（1.02-2.74）。
(4) 结论：前瞻性血液透析队列中，较低的膳食磷摄入量与更高的死亡风险相关。需要进一步的研究来阐明这一人群中特定膳食磷来源与死亡率之间的关系。
