Serum phosphate and social deprivation independently predict all-cause mortality in chronic kidney disease

BMC Nephrology

Research Article

Peter C. Thomson¹  Sarah Macpherson²  Sandosh Padmanabhan²  Patrick B. Mark³  Alan G Jardine³  Kathryn K Stevens³  Rajan K. Patel³  Mark D. Findlay³  Marit D. Solbu⁴ 

[1] Glasgow Renal & Transplant Unit, The Queen Elizabeth University Hospital, Glasgow, 1345 Govan Road, G51 4TF, Glasgow, UK;Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, G12 8TA, Glasgow, UK;Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, G12 8TA, Glasgow, UK;Glasgow Renal & Transplant Unit, The Queen Elizabeth University Hospital, Glasgow, 1345 Govan Road, G51 4TF, Glasgow, UK;Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, G12 8TA, Glasgow, UK;Section of Nephrology, University Hospital of North Norway, N-9038, Tromsø, Norway;

关键词: Chronic kidney disease;    Mortality;    Multiple deprivation;    Phosphate;    Renal replacement therapy;   

DOI  :  10.1186/s12882-015-0187-1

 received in 2015-07-09, accepted in 2015-11-13,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundHyperphosphataemia is linked to cardiovascular disease and mortality in chronic kidney disease (CKD). Outcome in CKD is also affected by socioeconomic status. The objective of this study was to assess the associations between serum phosphate, multiple deprivation and outcome in CKD patients.MethodsAll adult patients currently not on renal replacement therapy (RRT), with first time attendance to the renal outpatient clinics in the Glasgow area between July 2010 and June 2014, were included in this prospective study. Area socioeconomic status was assessed as quintiles of the Scottish Index of Multiple Deprivation (SIMD). Outcomes were all-cause and cardiovascular mortality and commencement of RRT.ResultsThe cohort included 2950 patients with a median (interquartile range) age 67.6 (53.6–76.9) years. Median (interquartile range) eGFR was 38.1 (26.3–63.5) ml/min/1.73 m2, mean (±standard deviation) phosphate was 1.13 (±0.24) mmol/L and 31.6 % belonged to the most deprived quintile (SIMD quintile I). During follow-up 375 patients died and 98 commenced RRT. Phosphate ≥1.50 mmol/L was associated with all-cause (hazard ratio (HR) 2.51; 95 % confidence interval (CI) 1.63-3.89) and cardiovascular (HR 5.05; 95 % CI 1.90–13.46) mortality when compared to phosphate 0.90–1.09 mmol/L in multivariable analyses. SIMD quintile I was independently associated with all-cause mortality. Phosphate did not weaken the association between deprivation index and mortality, and there was no interaction between phosphate and SIMD quintiles. Neither phosphate nor SIMD predicted commencement of RRT.ConclusionsMultiple deprivation and serum phosphate were strong, independent predictors of all-cause mortality in CKD and showed no interaction. Phosphate also predicted cardiovascular mortality. The results suggest that phosphate lowering should be pursued regardless of socioeconomic status.

【 授权许可】

CC BY   
© Solbu et al. 2015