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Titolo No independent association of serum phosphorus with risk for death or progression to end-stage renal disease in a large screen for chronic kidney disease
Autore Rajnish Mehrotra1, Carmen A. Peralta2, Shu-Cheng Chen3, Suying Li3, Michael Sachs1, Anuja Shah4, Keith Norris5, Georges Saab6, Adam Whaley-Connell7, Bryan Kestenbaum1 and Peter A. McCullough8 on behalf of the Kidney Early Evaluation Program (KEEP) Investigators9 - 1Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington, USA; 2San Francisco VA Medical Center, University of California, San Francisco, San Francisco, California, USA; 3Chronic Disease Research Group, Minneapolis, Minnesota, USA; 4Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA; 5Charles Drew University, Los Angeles, California, USA; 6Metro Health Medical Center, Cleveland, Ohio, USA; 7Harry S Truman Memorial Veterans Hospital and the University of Missouri–Columbia School of Medicine, Columbia, Missouri, USA and 8St John Providence Health System, Providence Hospitals and Medical Centers, Southfield and Novi, Michigan, USA
Referenza Kidney International 2013; 84: 989-997

Whether higher serum phosphorus levels are associated with a higher risk for death and/or progression of chronic kidney disease (CKD) is not well established, and whether the association is confounded by access and barriers to care is unknown. To answer these questions, data of 10,672 individuals identified to have CKD (estimated glomerular filtration rate o60 ml/min per 1.73m2) from those participating in a community-based screening program were analyzed. Over a median follow-up of 2.3 years, there was no association between quartiles of serum phosphorus and all-cause mortality (adjusted hazards ratio for serum phosphorus over 3.3 to 3.7, over 3.7 to 4.1, and over 4.1mg/dl, respectively: 1.22 (0.95–1.56), 1.00 (0.76–1.32), and 1.00 (0.75–1.33); reference, serum phosphorus of 3.3mg/dl and below). Individuals in the highest quartile for serum phosphorus had a significantly higher risk for progression to end-stage renal disease (ESRD) (unadjusted hazards ratio, 6.72 (4.16–10.85)); however, the risk became nonsignificant on adjustment for potential confounders. There was no appreciable change in hazards ratio with inclusion of variables related to access and barriers to care. Additional analyses in subgroups based on 12 different variables yielded similar negative associations. Thus, in the largest cohort of individuals with early-stage CKD to date, we could not validate an independent association of serum phosphorus with risk for death or progression to ESRD.

Data 21.05.2014
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