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Perit Dial Int 27(Supplement_3): 12- 2007
© 2007 International Society for Peritoneal Dialysis
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Calcium, Phosphorus, PTH

Serum Phosphorus and Mortality in Chronic Peritoneal Dialysis (CPD) Patients

R. Mehrotra1, O. Khawar1, U. Duong1, M. Shapiro2, C. McCallister2, J. Kopple1 and K. Kalantar-Zadeh1

LA Biomed at Harbor-UCLA Medical Center,1 Torrance; DaVita,2 El Segundo, California, USA.

Objective: Both very low and high serum phosphorus (phos) levels are related to survival in maintenance hemodialysis patients (pts). However, the mortality predictability of phos in CPD pts may be different. Methods: We examined a large and contemporary cohort of 7037 CPD pts who underwent dialysis treatment for at least 3 months in a DaVita dialysis clinic between July 2001 and June 2004. All phos values measured within 3-month calendar quarters were averaged into 1 single value. Results: Pts were 46.5±10.4 years old and included 48% women, 22% African Americans, 14% Hispanics, and 50% diabetics. Phos was categorized into 7 a priori selected groups of <3.5, ≥8.5, and 5 groups of 1-mg/dL increments in-between. In unadjusted Cox models, a low phos <3.5 mg/dL was associated with an increased death hazard ratio (HR) of 1.33 [95% confidence interval (CI): 1.0–1.60, p=0.003, reference: phos 4.5–5.5 mg/dL]. In multivariate adjusted models for case-mix (gender, age, race, ethnicity, dialysis vintage, residual renal function, and Kt/V) and malnutrition–inflammation complex syndrome [MICS] (serum albumin, creatinine, TIBC, WBC, calcium, PTH, lymphocyte percentage, and blood hemoglobin), phos ≥8.5 had a death HR of 1.37 (95% CI: 1.04–1.81, p=0.03).

<3.5 3.5 to <4.5 4.5 to <5.5 5.5 to <6.5 6.5 to <7.5 7.5 to <8.5 ≥8.5 Unadjusted 1.33 1.10 1.0 1.01 0.93 0.94 1.07 (1.10, 1.60) (0.96, 1.26) (0.88, 1.16) (0.78, 1.11) (0.72, 1.19) (0.82, 1.41) Case mix 1.15 1.03 1.0 1.07 1.05 1.11 1.35 (0.95, 1.39) (0.90, 1.18) (0.93, 1.23) (0.89, 1.26) (0.87, 1.43) (1.03, 1.77) Case mix & MICS 1.02 1.01 1.0 1.06 1.07 1.07 1.37 (0.84, 1.23) (0.88, 1.16) (0.92, 1.22) (0.90, 1.28) (0.84, 1.38) (1.04, 1.81)

Conclusions: Hence, in CPD pts the association between hypophosphatemia and death is due to confounders such as MICS, whereas severe hyperphosphatemia is an independent death predictor.






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