The benefit of reduced serum phosphate levels depends on patient characteristics: a nationwide prospective cohort study.

IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY
Clinical Kidney Journal Pub Date : 2024-10-04 eCollection Date: 2024-10-01 DOI:10.1093/ckj/sfae263
Shunsuke Goto, Takayuki Hamano, Hideki Fujii, Masatomo Taniguchi, Masanori Abe, Kosaku Nitta, Shinichi Nishi
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Abstract

Background: In cohort studies of hyperphosphatemic hemodialysis patients, reduced serum phosphate levels have been linked to a lower mortality risk. To investigate whether this benefit is influenced by patient characteristics, we calculated the number needed to be exposed (NNE), stratified by patient characteristics.

Methods: In this 9-year prospective cohort study using the nationwide Japanese registry, we enrolled 78 256 hemodialysis patients aged 18 years or older. We investigated the relationship between time-averaged (TA) phosphate levels and mortality due to cardiovascular disease (CVD) using Cox proportional models. We estimated the 1-year NNE for CVD death in patients with baseline serum phosphate levels ≥6.0 mg/dL and exposure to TA phosphate levels decreasing to 3.5-<5.0 mg/dL using mixed-effects Poisson models.

Results: The hazard ratio of CVD mortality decreased linearly with lower serum TA phosphate levels in those with prior atherosclerotic CVD (ACVD) or diabetic nephropathy (DN) but plateaued with serum phosphate <5.0 mg/dL in those without. The hazard ratios (95% confidence interval) for phosphate ≥7.0 mg/dL compared with 3.5-<3.9 mg/dL were 1.58 (1.38-1.81) in those with prior ACVD, 1.91 (1.68-2.17) in those without, 1.87 (1.63-2.16) in those with DN and 1.65 (1.46-1.87) in those without. However, the NNE for one more person to benefit (NNEB) for CVD death was lower in patients with a history of ACVD than in those without (61 vs 118). Patients with DN had lower NNEB than those without (69 vs 113). In patients with TA albumin ≥3.8 g/dL, older patients had lower NNEB, while patients with TA albumin <3.45 g/dL showed no benefit in some groups, including the elderly.

Conclusions: The benefit of intensive phosphate management may be pronounced in patients with a history of ACVD or DN. A comprehensive approach that considers both age and nutritional status may be necessary when managing serum phosphate levels.

降低血清磷酸盐水平的益处取决于患者特征:一项全国性前瞻性队列研究。
背景:在对高磷血症血液透析患者的队列研究中,降低血清磷酸盐水平与降低死亡风险有关。为了研究这种益处是否受患者特征的影响,我们计算了根据患者特征分层的暴露所需人数(NNE):在这项为期 9 年的前瞻性队列研究中,我们利用日本全国范围内的登记资料,招募了 78 256 名 18 岁或以上的血液透析患者。我们使用 Cox 比例模型研究了时间平均(TA)磷酸盐水平与心血管疾病(CVD)死亡率之间的关系。我们估算了基线血清磷酸盐水平≥6.0 mg/dL、TA磷酸盐水平降至3.5 mg/dL的患者1年心血管疾病死亡的NNE:在既往患有动脉粥样硬化性心血管疾病(ACVD)或糖尿病肾病(DN)的患者中,心血管疾病死亡率的危险比随着血清TA磷酸盐水平的降低而线性降低,但随着血清磷酸盐水平的降低而趋于稳定:强化磷酸盐管理对有 ACVD 或 DN 病史的患者的益处可能更为明显。在管理血清磷酸盐水平时,考虑年龄和营养状况的综合方法可能是必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Kidney Journal
Clinical Kidney Journal Medicine-Transplantation
CiteScore
6.70
自引率
10.90%
发文量
242
审稿时长
8 weeks
期刊介绍: About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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