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American Journal of Kidney Diseases

Serum Phosphorus and Progression of CKD and Mortality: A Meta-analysis of Cohort Studies

  • Author Footnotes
    ∗ J.D. and X.X. contributed equally to this work.
    Jingjing Da
    Footnotes
    ∗ J.D. and X.X. contributed equally to this work.
    Affiliations
    Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China

    Renal Division, Department of Medicine, Guizhou Provincial People's Hospital; Guizhou Provincial Institute of Nephritic & Urinary Disease, Guiyang, Guizhou
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  • Author Footnotes
    ∗ J.D. and X.X. contributed equally to this work.
    Xinfang Xie
    Footnotes
    ∗ J.D. and X.X. contributed equally to this work.
    Affiliations
    Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
    Search for articles by this author
  • Myles Wolf
    Affiliations
    Division of Nephrology and Hypertension, Department of Medicine, Division of Biostatistics, Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL
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  • Sinee Disthabanchong
    Affiliations
    Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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  • Jinwei Wang
    Affiliations
    Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
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  • Yan Zha
    Affiliations
    Renal Division, Department of Medicine, Guizhou Provincial People's Hospital; Guizhou Provincial Institute of Nephritic & Urinary Disease, Guiyang, Guizhou
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  • Jicheng Lv
    Correspondence
    Jicheng Lv, MD, Renal Division, Peking University First Hospital, 8, Xishiku St, Xicheng District, Beijing, China.
    Affiliations
    Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
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  • Luxia Zhang
    Correspondence
    Address correspondence to Luxia Zhang, MD, MPH, Renal Division, Peking University First Hospital, No. 8, Xishiku St, Xicheng District, Beijing China
    Affiliations
    Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
    Search for articles by this author
  • Author Footnotes
    † Deceased.
    Haiyan Wang
    Footnotes
    † Deceased.
    Affiliations
    Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
    Search for articles by this author
  • Author Footnotes
    ∗ J.D. and X.X. contributed equally to this work.
    † Deceased.
Published:March 24, 2015DOI:https://doi.org/10.1053/j.ajkd.2015.01.009

      Background

      Recent studies have indicated that phosphorus may play an independent pathogenic role in chronic kidney disease (CKD) progression, but some of those studies were underpowered and yielded inconsistent results.

      Study Design

      Systematic review and meta-analysis.

      Setting & Population

      Non–dialysis-dependent patients with CKD (transplant recipients were excluded).

      Selection Criteria for Studies

      Studies assessing the risk ratio of serum phosphorus level on kidney failure and mortality for non–dialysis-dependent patients with CKD published from January 1950 to June 2014 were included following systematic searching of MEDLINE, EMBASE, and the Cochrane Library.

      Predictor

      Serum phosphorus level.

      Outcome

      Kidney failure, defined as doubled serum creatinine level, 50% decline in estimated glomerular filtration rate, or end-stage kidney disease.

      Results

      In 12 cohort studies with 25,546 patients, 1,442 (8.8%) developed kidney failure and 3,089 (13.6%) died. Overall, every 1-mg/dL increase in serum phosphorus level was associated independently with increased risk of kidney failure (hazard ratio, 1.36; 95% CI, 1.20-1.55) and mortality (hazard ratio, 1.20; 95% CI, 1.05-1.37).

      Limitations

      Existence of potential residual confounding could not be excluded.

      Conclusions

      This meta-analysis suggests an independent association between serum phosphorus level and kidney failure and mortality among non–dialysis-dependent patients with CKD and suggests that large-scale randomized controlled trials should target disordered phosphorus homeostasis in CKD.

      Index Words

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