Advances in Clinical and Experimental Medicine
2018, vol. 27, nr 9, September, p. 1239–1245
Publication type: original article
Phosphorus is an independent risk factor for the progression of diabetic nephropathy
1 National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, China
Background. Serum phosphorus is thought to be an important risk factor for the progression of chronic kidney disease (CKD). However, the association of serum phosphorus with disease progression in patients with different causes of kidney diseases remains to be elucidated.
Objectives. The aim of this study was to estimate the effect of serum phosphorus on disease progression in 2 cohorts of CKD with different causes.
Material and Methods. A total of 591 patients with diabetic nephropathy and 957 patients with IgA nephropathy from the National Clinical Research Center of Kidney Diseases, Nanjing, China, with biopsy-proven kidney disease, stage 1–4 CKD and a follow-up of at least 1 year were recruited. We evaluated the relationship between the baseline phosphorus category and the disease progression in the 2 cohorts.
Results. Multivariate Cox regression analyses indicated that the risk of the endpoint event was 1.68-fold higher (95% confidence interval (CI): 0.95–2.91) in IgA nephropathy patients and 2.88-fold higher (95% CI: 1.12–5.04) in diabetic nephropathy patients with the highest quartile of serum phosphorus compared with the risk of those with the lowest quartile.
Conclusion. The association of serum phosphorus with the progression of CKD may vary in specific CKD patient subgroups. Serum phosphorus is independently associated with the progression of kidney disease in patients with diabetic nephropathy.
risk factors, chronic kidney disease, phosphorus, IgA nephropathy, diabetic nephropathy
- Eckardt KU, Coresh J, Devuyst O, et al. Evolving importance of kidney disease: From subspecialty to global health burden. Lancet. 2013; 382(9887):158–169.
- Da J, Xie X, Wolf M, et al. Serum phosphorus and progression of CKD and mortality: A meta-analysis of cohort studies. Am J Kidney Dis. 2015;66(2):258–265.
- O’Seaghdha CM, Hwang SJ, Muntner P, et al. Serum phosphorus predicts incident chronic kidney disease and end-stage renal disease. Nephrol Dial Transplant. 2011;26(9):2885–2890.
- Mehrotra R, Peralta CA, Chen SC, et al. No independent association of serum phosphorus with risk for death or progression to end-stage renal disease in a large screen for chronic kidney disease. Kidney Int. 2013;84(5):989–997.
- Schwarz S, Trivedi BK, Kalantar-Zadeh K, Kovesdy CP. Association of disorders in mineral metabolism with progression of chronic kidney disease. Clin J Am Soc Nephrol. 2006;1(4):825–831.
- Wahl P, Xie H, Scialla J, et al. Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease. Diabetes Care. 2012;35(5):994–1001.
- Le W, Liang S, Hu Y, et al. Long-term renal survival and related risk factors in patients with IgA nephropathy: Results from a cohort of 1155 cases in a Chinese adult population. Nephrol Dial Transplant. 2012;27(4):1479–1485.
- An Y, Xu F, Le W, et al. Renal histologic changes and the outcome in patients with diabetic nephropathy. Nephrol Dial Transplant. 2015; 30(2):257–266.
- Stevens PE, Levin A; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825−830.
- Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–612.
- Slatopolsky E, Moe S. 50 years of research and discovery in chronic kidney disease and mineral & bone disorder: The central role of phosphate. Kidney Int. 2011;79(S121):S1–S2.
- Norris KC, Greene T, Kopple J, et al. Baseline predictors of renal disease progression in the African American study of hypertension and kidney disease. J Am Soc Nephrol. 2006;17(10):2928–2936.
- Scialla JJ, Astor BC, Isakova T, Xie H, Appel LJ, Wolf M. Mineral metabolites and CKD progression in African Americans. J Am Soc Nephrol. 2013;24(1):125–135.
- Chue CD, Edwards NC, Davis LJ, Steeds RP, Townend JN, Ferro CJ. Serum phosphate but not pulse wave velocity predicts decline in renal function in patients with early chronic kidney disease. Nephrol Dial Transplant. 2011;26(8):2576–2582.
- Block GA, Ix JH, Ketteler M, et al. Phosphate homeostasis in CKD: Report of a scientific symposium sponsored by the National Kidney Foundation. Am J Kidney Dis. 2013;62(3):457–473.
- Haynes R, Staplin N, Emberson J, et al. Evaluating the contribution of the cause of kidney disease to prognosis in CKD: Results from the study of heart and renal protection (SHARP). Am J Kidney Dis. 2014;64(1):40–48.
- Ekart R, Ferjuc A, Furman B, Gerjevič Š, Bevc S, Hojs R. Chronic kidney disease progression to end stage renal disease: A single center experience of the role of the underlying kidney disease. Ther Apher Dial. 2013;17(4):363–367.
- Tanaka H, Hamano T, Fujii N, et al. The impact of diabetes mellitus on vitamin D metabolism in predialysis patients. Bone. 2009;45(5):949–955.
- Mehrotra R. Disordered mineral metabolism and vascular calcification in nondialyzed chronic kidney disease patients. J Ren Nutr. 2006;16(2):100–118.
- Chen H, Li X, Yue R, Ren X, Zhang X, Ni A. The effects of diabetes mellitus and diabetic nephropathy on bone and mineral metabolism in T2DM patients. Diabetes Res Clin Pract. 2013;100(2):272–276.
- Bellasi A, Mandreoli M, Baldrati L, et al. Chronic kidney disease progression and outcome according to serum phosphorus in mild-to-moderate kidney dysfunction. Clin J Am Soc Nephrol. 2011;6(4):883–891.
- Fliser D, Kollerits B, Neyer U, et al. Fibroblast growth Factor 23 (FGF23) predicts progression of chronic kidney disease: The Mild to Moderate Kidney Disease (MMKD) study. J Am Soc Nephrol. 2007;18(9):2600–2608.
- Neves KR, Graciolli FG, dos Reis LM, Pasqualucci CA, Moysés RM, Jorgetti V. Adverse effects of hyperphosphatemia on myocardial hypertrophy, renal function, and bone in rats with renal failure. Kidney Int. 2004;66(6):2237–2244.
- Newsome B, Ix JH, Tighiouart H, et al. Effect of protein restriction on serum and urine phosphate in the Modification of Diet in Renal Disease (MDRD) study. Am J Kidney Dis. 2013;61(6):1045–1046.
- Isakova T, Barchi-Chung A, Enfield G, et al. Effects of dietary phosphate restriction and phosphate binders on FGF23 levels in CKD. Clin J Am Soc Nephrol. 2013;8(6):1009–1018.
- Navarro-González JF, Mora-Fernández C, Muros M, Herrera H, García J. Mineral metabolism and inflammation in chronic kidney disease patients: A cross-sectional study. Clin J Am Soc Nephrol. 2009;4(10):1646–1654.
- Nadkarni GN, Uribarri J. Phosphorus and the kidney: What is known and what is needed. Adv Nutr. 2014;5(1):98–103.
- Kanbay M, Goldsmith D, Akcay A, Covic A. Phosphate – the silent stealthy cardiorenal culprit in all stages of chronic kidney disease: A systematic review. Blood Purif. 2009;27(2):220–230.
- Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease. Kidney Int. 2007;71(1):31–38.