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Higher serum phosphorus predicts residual renal function loss in male but not female incident peritoneal dialysis patients

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Abstract

Background

Elevated serum phosphorus level is a risk factor for progression of chronic kidney disease in non-dialysis patients. However, the association of serum phosphorus level with residual renal function (RRF) loss among incident continuous ambulatory peritoneal dialysis (CAPD) patients remains unclear.

Methods

We performed a retrospective analysis of prospectively collected cohort of 1245 incident CAPD patients from January 2006 to December 2015 and followed up until December 2017. Patients were stratified into tertiles according to baseline serum phosphorus levels. RRF loss was defined as residual glomerular filtration rate (mL/min/1.73 m2) reaching zero or estimated urine output less than 200 mL/day on two successive clinic visits. Propensity-score matched Cox’s proportional hazards and competing risk models were performed to examine the association of serum phosphorus with RRF loss.

Results

A total of 421 (33.82%) patients had loss of RRF over a median follow-up of 26.23 months. In the entire cohort, elevated serum phosphorus was associated with increased risk for RRF loss after adjustment. In the propensity-score matched cohort, patients in the 3rd tertile of serum phosphorus had a 51% higher risk of RRF loss than those in the combination of the 1st and 2nd tertiles. Furthermore, the association of serum phosphorus level with RRF loss differed by sex (interaction P = 0.018). The adjusted HRs per 1 mg/dL increase in serum phosphorus level of RRF loss were 1.32 (95% CI 1.15–1.50, P < 0.001) for male and 1.03 (95% CI 0.87–1.21, P = 0.750) for female, respectively. These findings persisted in competing risk analysis.

Conclusion

Higher serum phosphorus levels independently predicts RRF loss in men treated with CAPD.

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Funding

This work was supported by grants from the Guangzhou Committee of Science and Technology, China (2010U1-E00831), the PhD Start-up Fund of Natural Science Foundation of Guangdong Province, China (S2013040012953), Key Laboratory of Nephrology, Guangdong Province, Guangzhou, China (2002B60118), and Operational Grant of Guangdong Provincial Key Laboratory (2017B030314019).

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Author notes

  1. Jiani Shen and Wei Li contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China

    Jiani Shen, Yating Wang, Hongyu Li, Jiali Wang, Zhong Zhong, Fengxian Huang, Xueqing Yu & Haiping Mao

  2. Key Laboratory of Nephrology, Ministry of Health of China, Guangzhou, China

    Jiani Shen, Yating Wang, Hongyu Li, Jiali Wang, Zhong Zhong, Fengxian Huang, Xueqing Yu & Haiping Mao

  3. Department of Nephrology, First People’s Hospital of Foshan, Foshan, China

    Wei Li & Yaozhong Kong

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  1. Jiani Shen
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Contributions

HPM, JNS and WL contributed to the study conception and design. JNS and WL performed analyses of data, interpretation of data and drafting manuscript. YTW, HYL, JLW, ZZ and YZK contributed to data collection and manuscript revision. HPM, XFH, and XQY provided overall supervision.

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Correspondence to Haiping Mao.

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All participants provided written informed consents. The study was approved by the First Affiliated Hospital of Sun Yat-sen University Institutional Review Boards.

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40620_2019_670_MOESM1_ESM.docx

Supplementary material 1: Table S1. Clinical characteristics of PD Patients with different serum phosphorus levels before and after propensity score matching (DOCX 14 kb)

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Shen, J., Li, W., Wang, Y. et al. Higher serum phosphorus predicts residual renal function loss in male but not female incident peritoneal dialysis patients. J Nephrol 33, 829–837 (2020). https://doi.org/10.1007/s40620-019-00670-7

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