Kang Seok-Hui, Park So-Young, Lim Yu-Jeong, Kim Bo-Yeon, Choi Ji-Young, Do Jun-Young, Kim A-Young
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea.
Department of Physiology, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea.
Nutrients. 2025 Apr 30;17(9):1528. doi: 10.3390/nu17091528.
There are few studies investigating the relationship between phosphate level variability and clinical prognosis in hemodialysis (HD) patients. This study aimed to evaluate the impact of phosphate variability on clinical outcomes in maintenance HD patients using a population-based cohort.
We analyzed data from 55,225 patients who underwent periodic HD quality assessments and claims review. Phosphate variability was assessed using the residual standard deviation (SD) from a within-subject linear regression model based on six phosphate measurements per patient. Participants were categorized into quartiles based on phosphate variability. A balanced cohort was created using generalized boosted models for relevant covariates.
After weighting, the residual phosphate SDs were 0.35 ± 0.00 mg/dL (Q1), 0.57 ± 0.00 mg/dL (Q2), 0.79 ± 0.00 mg/dL (Q3), and 1.22 ± 0.00 mg/dL (Q4). The mean follow-up duration across all quartiles was 50 ± 0.2 months. Multivariable Cox regression analysis revealed that patients in the Q4 group had a significantly higher hazard ratio (HR) for all-cause mortality and dementia compared with the Q1 group. Among all quartiles, Q1 showed the lowest HR for dementia. These trends were consistent with those observed in spline curve analyses. However, no significant association was found between phosphate variability and cardiovascular events.
High phosphate variability was associated with increased risk of all-cause mortality and dementia in maintenance HD patients.
很少有研究调查血液透析（HD）患者中磷水平变异性与临床预后之间的关系。本研究旨在使用基于人群的队列评估磷变异性对维持性HD患者临床结局的影响。
我们分析了55225例接受定期HD质量评估和理赔审查的患者的数据。使用基于每位患者6次磷测量值的受试者内线性回归模型的残差标准差（SD）评估磷变异性。参与者根据磷变异性分为四分位数。使用广义增强模型对相关协变量创建一个平衡队列。
加权后，残差磷标准差分别为0.35±0.00mg/dL（Q1）、0.57±0.00mg/dL（Q2）、0.79±0.00mg/dL（Q3）和1.22±0.00mg/dL（Q4）。所有四分位数的平均随访时间为50±0.2个月。多变量Cox回归分析显示，与Q1组相比，Q4组患者全因死亡率和痴呆的风险比（HR）显著更高。在所有四分位数中，Q1组痴呆的HR最低。这些趋势与样条曲线分析中观察到的趋势一致。然而，未发现磷变异性与心血管事件之间存在显著关联。
高磷变异性与维持性HD患者全因死亡率和痴呆风险增加相关。
