Hyperphosphatemia-Related Mortality Is Modified by Serum Albumin and Creatinine Levels in Hemodialysis Patients: The Q-Cohort Study

IF 4 3区医学 Q2 NUTRITION & DIETETICS

Journal of Renal Nutrition Pub Date : 2026-09-01 Epub Date: 2026-05-12 DOI:10.1053/j.jrn.2026.04.012

Shunsuke Yamada MD, PhD, Hokuto Arase MD, PhD, Masanori Tokumoto MD, PhD, Masatomo Taniguchi MD, PhD, Kazuhiko Tsuruya MD, PhD, Toshiaki Nakano MD, PhD, Tetsuro Ago MD, PhD

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引用次数: 0

Abstract

Objective

Hyperphosphatemia is a well-established predictor of mortality in hemodialysis patients. However, its impact may vary depending on clinical conditions. We examined whether serum albumin and creatinine (Cr) levels modify the association between hyperphosphatemia and mortality.

Design and Methods

We conducted a prospective, multicenter cohort study involving 3,050 patients on maintenance hemodialysis, followed for up to 4 years. The primary outcomes were all-cause and cardiovascular mortality. Serum phosphorus levels were the main exposure; serum albumin and Cr levels were evaluated as potential effect modifiers. Sensitivity analyses were performed using the Geriatric Nutritional Risk Index and modified creatinine index. Cox proportional hazards models were used to assess mortality risk.

Results

Over a median follow-up of 3.5 years, 639 patients died, including 227 from cardiovascular causes. In multivariable-adjusted models, hyperphosphatemia was significantly associated with higher risks of both all-cause and cardiovascular mortality. Stratified analyses revealed that this association was significant only in patients with higher serum albumin or lower Cr levels. Among patients with lower albumin or higher Cr, the association was not significant. Significant interaction effects were observed between serum phosphorus and both albumin and Cr, highlighting a potential modifying role of nutritional and muscular status in phosphate-related mortality risk. In sensitivity analyses, similar patterns were observed, with the association between hyperphosphatemia and mortality being more evident among patients with higher Geriatric Nutritional Risk Index and lower modified creatinine index.

Conclusion

The prognostic impact of hyperphosphatemia may differ according to serum albumin and Cr levels in patients undergoing hemodialysis.

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血透患者血清白蛋白和肌酐水平改变高磷血症相关死亡率：q队列研究

目的：高磷血症是血液透析患者死亡率的可靠预测指标。然而，其影响可能因临床情况而异。我们研究了血清白蛋白和肌酐水平是否改变了高磷血症和死亡率之间的关系。设计和方法：我们进行了一项前瞻性、多中心队列研究，涉及3050例维持性血液透析患者，随访时间长达4年。主要结局为全因死亡率和心血管死亡率。血清磷水平是主要暴露，血清白蛋白和肌酐水平作为潜在的影响调节因素进行评估。采用老年营养风险指数（GNRI）和改良肌酐指数（mCI）进行敏感性分析。采用Cox比例风险模型评估死亡风险。结果：在中位3.5年的随访中，639例患者死亡，其中227例死于心血管疾病。在多变量调整模型中，高磷血症与全因死亡率和心血管死亡率的高风险显著相关。分层分析显示，这种关联仅在血清白蛋白较高或肌酐水平较低的患者中具有显著性。在白蛋白较低或肌酐较高的患者中，相关性不显著。血清磷与白蛋白和肌酐之间观察到显著的相互作用，强调了营养和肌肉状态在磷酸盐相关死亡风险中的潜在调节作用。在敏感性分析中，观察到类似的模式，高磷血症和死亡率之间的关联在高GNRI和低mCI的患者中更为明显。结论：高磷血症对血液透析患者预后的影响可能因血清白蛋白和肌酐水平的不同而不同。

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来源期刊

Journal of Renal Nutrition 医学-泌尿学与肾脏学

CiteScore

5.70

自引率

12.50%

发文量

146

审稿时长

6.7 weeks

期刊介绍： The Journal of Renal Nutrition is devoted exclusively to renal nutrition science and renal dietetics. Its content is appropriate for nutritionists, physicians and researchers working in nephrology. Each issue contains a state-of-the-art review, original research, articles on the clinical management and education of patients, a current literature review, and nutritional analysis of food products that have clinical relevance.