Association of Serum Phosphorus Concentration with Mortality and Graft Failure among Kidney Transplant Recipients

Clinical journal of the American Society of Nephrology: CJASN

Hee Jung Jeon¹ 

[1]Departments of *Internal Medicine and..Departments of *Internal Medicine and..Departments of *Internal Medicine and..‡Graduate School of Public Health, Seoul National University,..§Surgery, Seoul National University College of Medicine,..‖Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, and..†Department of Internal Medicine, Kangdong Sacred Heart Hospital,..Departments of ¶Internal Medicine and..**Surgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea..Departments of *Internal Medicine and..Departments of *Internal Medicine and..Departments of *Internal Medicine and..‖Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, and..

关键词: mortality;    graft survival;    phosphorus;    cardiovascular diseases;    confidence intervals;    diabetes mellitus;    follow-up studies;    glomerular filtration rate;    graft survival;    humans;    hyperphosphatemia;    hypophosphatemia;    incidence;    kidney;    kidney transplantation;    living donors;    male;    multivariate analysis;    phosphorus;    phosphorus, dietary;    proportional hazards models;    retrospective studies;    survival analysis;   

DOI  :  10.2215/CJN.07090716

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Hyperphosphatemia in kidney transplant recipients has been shown to predict poorer graft and patient survival. However, studies examining hypophosphatemia are scarce.Design, setting, participants, & measurements To evaluate the association of serum phosphorus level with patient and graft survival, we performed a retrospective multicenter cohort study. Between January of 1997 and August of 2012, 2786 kidney transplant recipients (41.7±11.4 years; 59.3% men; 73.5% living donors; 26.1% with diabetes; 3.8% with prior history of cardiovascular disease) were classified into seven groups according to serum phosphorus levels 1 year after transplantation, with intervals of 0.5 mg/dl (lowest group, <2.5 mg/dl; highest group, ≥5.0 mg/dl; reference group, 3.5–3.99 mg/dl). Survival analysis was performed by defining baseline time point as 1 year after transplantation.Results During median follow-up of 78.5 months, 60 patient deaths and 194 cases of graft loss occurred. In multivariate analysis, both lowest and highest serum phosphorus groups were associated with higher mortality, compared with the reference group (hazard ratio [HR], 4.82; 95% confidence interval [95% CI], 1.36 to 17.02; P=0.01; and HR, 4.24; 95% CI, 1.07 to 16.84; P=0.04, respectively). Higher death-censored graft loss was observed in the lowest and highest groups (HR, 3.32; 95% CI, 1.42 to 7.79; P=0.01; and HR, 2.93; 95% CI, 1.32 to 6.49; P=0.01, respectively), despite eGFR exhibiting no difference between the lowest group and reference group (65.4±19.3 versus 61.9±16.7 ml/min per 1.73 m2; P=0.33). Moreover, serum phosphorus showed a U-shape association with patient mortality and graft failure in restricted cubic spline curve analysis.Conclusions Serum phosphorus level 1 year after transplantation exhibits a U-shape association with death-censored graft failure and patient mortality in kidney transplant patients characterized by relatively high rate of living donor transplant and low incidence of diabetes and prior cardiovascular disease compared with Western countries.

【 授权许可】

CC BY