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Relationship between serum phosphate levels and survival in chronic hemodialysis patients: interactions with age, malnutrition and inflammation.
Ye, Xiaoling; Kooman, Jeroen P; van der Sande, Frank M; Raimann, Jochen G; Usvyat, Len A; Wang, Yuedong; Maddux, Franklin W; Kotanko, Peter.
Afiliación
  • Ye X; Research Department, Renal Research Institute, New York, NY, USA.
  • Kooman JP; Nephrology Department, Maastricht University Medical Centre, Maastricht, The Netherlands.
  • van der Sande FM; Nephrology Department, Maastricht University Medical Centre, Maastricht, The Netherlands.
  • Raimann JG; Research Department, Renal Research Institute, New York, NY, USA.
  • Usvyat LA; Research Department, Renal Research Institute, New York, NY, USA.
  • Wang Y; Global Medical Office, Fresenius Medical Care, Waltham, MA, USA.
  • Maddux FW; Department of Statistics and Applied Probability, University of California-Santa Barbara, Santa Barbara, CA, USA.
  • Kotanko P; Global Medical Office, Fresenius Medical Care, Waltham, MA, USA.
Clin Kidney J ; 14(1): 348-357, 2021 Jan.
Article en En | MEDLINE | ID: mdl-33564438
BACKGROUND: Evidence indicates that the inverse relationships between phosphate levels and mortality maybe modified by age. Furthermore, malnutrition and inflammation could strengthen the risk associated with phosphate abnormalities. This study aimed to assess the associations between phosphate levels and mortality while accounting for the interactions with age and parameters associated with malnutrition and inflammation in hemodialysis (HD) patients. METHODS: Adult HD patients (n = 245 853) treated in Fresenius Medical Care North America clinics from January 2010 to October 2018 were enrolled. Baseline was defined as Months 4-6 on dialysis, with the subsequent 12 months as the follow-up period. Univariate and multivariate Cox proportional hazard models with spline terms were applied to study the nonlinear relationships between serum phosphate levels and mortality. The interactions of phosphate levels with albumin, creatinine, normalized protein catabolic rate (nPCR) and neutrophil-lymphocyte ratio (NLR) were assessed with smoothing spline analysis of variance Cox proportional hazard models. RESULTS: Older patients tended to have lower levels of serum phosphate, albumin, creatinine and nPCR. Additionally, both low (<4.0 mg/dL) and high (>5.5 mg/dL) phosphate levels were associated with higher risk of mortality across all age strata. The U-shaped relationships between phosphate levels and outcome persisted even for patients with low or high levels of serum albumin, creatinine, nPCR and NLR, respectively. CONCLUSION: The consistent U-shaped relationships between serum phosphate and mortality across age strata and levels of inflammatory and nutritional status should prompt the search for underlying causes and potentially nutritional intervention in clinical practice.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Clin Kidney J Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Clin Kidney J Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos
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