Article Figures & Data
Figures
- Figure 1.
(A) Overall likelihood of experiencing the composite end point according to quartile of serum phosphorus. (B) The HR of experiencing the composite end point according to serum phosphorous levels adjusted for age, case mix, hemoglobin, total calcium, uric acid and ACE inhibitors, vitamin D, and calcium salts use. The solid line represents the HR according to serum phosphorous level; the grey area represents the 95% CI.
- Figure 2.
Association between hyperphosphatemia (serum phosphorus ≥4.3 mg/dl) and the composite outcome (death or progression to ESRD) in different CKD-NDD subgroups. Here are depicted the HR associated with hyperphosphatemia compared with the reference group (serum phosphorus ≥3.3 but <3.8 mg/dl) in different stages of CKD, age category, sex, and diabetes status. All results are adjusted for the case mix and hemoglobin, total calcium, uric acid, ACE inhibitors, vitamin D, and calcium salts use.
- Figure 3.
Overall likelihood of progression to end-stage renal disease and dialysis inception according to the serum phosphorous quartile.
- Figure 4.
Overall likelihood of all causes of death according to the serum phosphorous quartile.
Tables
- Table 1.
Demographic, clinical, and laboratory characteristics of the entire study cohort and according to quartiles of phosphorus
Variable Overall (n = 1716) Quartiles of Serum Phosphorus P Trend P < 3.3 mg/dl (n = 382) P ≥ 3.3 mg/dl and < 3.8 mg/dl (n = 426) P ≥ 3.8 mg/dl and < 4.3 mg/dl (n = 479) P ≥ 4.3 (n = 429) Demographic variables age (years) 70.0 (13.6) 72.0 (11.3) 71.6 (12.8) 69.6 (13.9) 67.2 (15.2) <0.001 male gender (%) 66.2 84.3 68.5 61.4 53.1 <0.001 Clinical variables hypertension (%) 96.3 96.1 97.1 96 96.2 0.78 diabetes mellitus (%) 29.0 20.2 25.2 34.0 34.8 0.001 COPD (%) 11.6 12.9 12.8 11.1 9.9 0.47 CVD (%) 36.7 39.8 39.4 35.7 32.6 0.10 CKD (%) stage 3 37.0 37.1 30.8 23.7 8.3 <0.001 stage 4 46.6 17.0 25.0 32.8 25.2 <0.001 stage 5 16.2 3.6 10.8 23.3 62.4 <0.001 Laboratory variables phosphorus (mg/dl) 3.9 (2.13) 2.9 (0.3) 3.5 (1.4) 4.0 (0.16) 5.2 (3.9) <0.001 calcium (mg/dl) 9.0 (0.93) 9.1 (1.0) 9.0 (0.9) 9.0 (0.9) 8.8 (0.9) 0.006 iPTH (ng/ml) 178 [73 to 178] 98 [68 to 169] 119 [71 to 185] 117 [75 to 203] 173 [96 to 334] <0.001 hemoglobin (mg/dl) 12.5 (3.3) 13.2 (1.7) 12.6 (1.6) 12.2 (5.7) 11.6 (1.6) <0.001 total cholesterol (mg/dl) 192 (42) 191 (41) 191 (40) 193 (45) 193 (43) 0.91 HDL cholesterol (mg/dl) 51.9 (15) 49.5 (13) 51.4 (14) 53.1 (16) 53.8 (16) 0.01 triglycerides (mg/dl) 149 (81) 155 (83) 140 (74) 152 (83) 149 (81) 0.09 uric acid (mg/dl) 6.3 [5.2 to 7.4] 6.3 [5.6 to 7.4] 6.2 [5.6 to 7.4] 6.3 [5.1 to 7.3] 6.2 [5.2 to 7.6] 0.55 glucose (mg/dl) 108 (38) 106 (34) 107 (41) 112 (42) 105 (34) 0.08 creatinine (mg/dl) 2.3 [1.8 to 3.1] 1.9 [1.6 to 2.3] 2.0 [1.7 to 2.7] 2.4 [1.8 to 2.9] 3.2 [2.3 to 4.4] <0.001 GFR (mg/min per 1.73 m2) 25 [18 to 34] 32 [25 to 40] 28 [21 to 36] 24 [18 to 32] 17 [12 to 24] <0.001 Concomitant medications calcium salts 15.9 6.4 9.4 14.6 32.5 <0.001 vitamin D 16.1 9.8 13.5 16.7 23.9 <0.001 ARB 31.7 32.1 31.3 33.5 29.9 0.71 ACE inhibitors 46.7 47.2 49.0 47.4 43.3 0.39 other hypertensive medications 24.5 19.4 25.0 24.7 28.5 0.03 Data are expressed as mean (standard deviation) or median [IQR] when appropriate. ARB, Angiotensin Receptor Blockers.
- Table 2.
Association between hyperphosphatemia and the composite outcome (death or progression to ESRD) in the study cohort
Variable Overall (n = 1716) Age-Adjusted Case Mix Modela Cox Full Modelb HR 95% CI P HR 95% CI P HR 95% CI P P < 3.3 mg/dl 0.64 0.42 to 0.96 0.03 0.75 0.49 to 1.14 0.18 0.78 0.51 to 1.19 0.25 P ≥ 3.3 and < 3.8 Ref Ref Ref P ≥ 3.8 and < 4.3 1.29 0.91 to 1.81 0.14 0.98 0.69 to 1.39 0.94 0.93 0.66 to 1.33 0.72 P ≥ 4.3 4.01 2.93 to 5.47 <0.001 2.32 1.64 to 3.27 <0.001 2.04 1.44 to 2.90 <0.001 - Table 3.
Predictors of the composite end point, progression to ESRD, and all-cause mortality
Variable Composite End Point Progression to ESRD All-Cause Mortality HR 95% CI P HR 95% CI P HR 95% CI P Demographics age (per 1 year) 1.01 1.00 to 1.02 0.003 0.99 0.98 to 1.00 0.19 1.09 1.06 to 1.11 <0.001 men versus women 1.40 1.06 to 1.83 0.01 1.36 0.96 to 1.91 0.07 1.85 1.15 to 2.99 0.01 Clinical variables diabetes 1.20 0.93 to 1.55 0.15 1.31 0.94 to 1.84 0.10 1.41 0.93 to 2.14 0.10 hypertension 1.86 0.67 to 5.15 0.22 1.94 0.58 to 6.44 0.27 3.15 0.42 to 23.5 0.26 COPD 1.10 0.73 to 1.64 0.63 0.88 0.46 to 1.66 0.69 0.91 0.49 to 1.71 0.97 CVD 0.91 0.68 to 1.21 0.81 0.96 0.64 to 1.43 0.85 1.16 0.74 to 1.82 0.50 Laboratory variables serum phosphate (mg/dl) P < 3.3 0.78 0.51 to 1.19 0.25 0.61 0.30 to 1.24 0.17 0.74 0.43 to 1.28 0.29 P ≤ 3.3 and < 3.8 Ref Ref Ref Ref Ref Ref Ref Ref Ref P ≥ 3.8 and < 4.3 0.93 0.66 to 1.33 0.72 1.36 0.84 to 2.18 0.20 0.64 0.36 −1.14 0.13 P ≥ 4.3 2.04 1.44 to 2.90 <0.001 2.88 1.77 to 4.67 <0.001 2.49 1.44 to 4.32 0.001 eGFR (ml/min) 0.94 0.91 to 0.97 <0.001 0.88 0.86 to 0.91 <0.001 0.97 0.95 to 0.99 0.02 hemoglobin (>12.4 g/dl) 0.72 0.55 to 0.94 0.01 0.76 0.53 to 1.10 0.15 0.75 0.50 to 1.12 0.16 calcium (mg/dl) 0.88 0.74 to 1.04 0.15 0.75 0.61 to 0.92 0.005 1.01 0.78 to 1.31 0.90 total cholesterol (mg/dl) 0.99 0.99 to 1.00 0.40 0.99 0.99 to 1.00 0.30 1.00 0.99 to 1.00 0.99 uric acid (mg/dl) 1.01 0.99 to 1.02 0.36 1.00 0.93 to 1.08 0.86 1.00 0.99 to 1.02 0.16 Concomitant medications ACE inhibitor use 1.01 0.78 to 1.29 0.93 0.85 0.60 to 1.18 0.34 1.18 0.80 to 1.75 0.31 ARBs use 1.36 1.03 to 1.78 0.02 1.34 0.95 to −1.90 0.09 1.24 0.88 to 2.09 0.16 vitamin D use 1.11 0.81 to 1.50 0.49 1.39 0.96 to 2.03 0.08 1.39 0.83 to 2.93 0.20 calcium salts use 1.36 1.03 to 1.81 0.02 1.17 0.82 to 1.66 0.37 1.26 0.77 to 2.05 0.33 ARB, Angiotensin Receptor Blockers.
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