ArticlePloS one2016
The Impact of Normal Range of Serum Phosphorus on the Incidence of End-Stage Renal Disease by A Propensity Score Analysis.
Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 29 citations in OpenAlex.
- Site-specific biomechanical alterations of the knee during gait in ACL-deficient patients with concomitant cartilage lesions.Frontiers in bioengineering and biotechnology · 2026Article
- Chronic ACLD Knees with Early Developmental Cartilage Lesions Exhibited Increased Posterior Tibial Translation during Level Walking.Orthopaedic surgery · 2024Article
- The association of normal-range serum phosphorus with immunoglobulin A nephropathy progression: a retrospective cohort study.International urology and nephrology · 2024Article
- Why do patients with isolated PCL rupture experience no subjective knee joint instability during walking? AnFrontiers in bioengineering and biotechnology · 2024Article
- The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series.International journal of environmental research and public health · 2023Article
- Association between Serum Inorganic Phosphorus Levels and Adverse Outcomes in Chronic Kidney Disease: The Fukushima CKD Cohort Study.Internal medicine (Tokyo, Japan) · 2022Article
- Postdialysis serum phosphate equilibrium in hemodialysis patients on a controlled diet and no binders.Hemodialysis international. International Symposium on Home Hemodialysis · 2022Article
- Association between serum phosphorus and mortality in NHANES 2003-2006: the effect of gender and renal function.Journal of nephrology · 2022Article
- Association between serum phosphate and mortality in critically ill patients: a large retrospective cohort study.BMJ open · 2021Article
- Dietary Phosphorus as a Marker of Mineral Metabolism and Progression of Diabetic Kidney Disease.Nutrients · 2021Review
- Development of a Biomarker Panel to Distinguish Risk of Progressive Chronic Kidney Disease.Biomedicines · 2020Article
- Severe chronic kidney disease environment reduced calcium-sensing receptor expression in parathyroid glands of adenine-induced rats even without high phosphorus diet.BMC nephrology · 2020Article
- Observational
- High Serum Phosphate Level as a Risk Factor to Determine Renal Prognosis in Autosomal Dominant Polycystic Kidney Disease: A Retrospective Study.Medicines (Basel, Switzerland) · 2020Article
- Hyperphosphatemia and risks of acute kidney injury, end-stage renal disease, and mortality in hospitalized patients.BMC nephrology · 2019Article
- Relative hypophosphatemia early after transplantation is a predictor of good kidney graft function.Clinical and experimental nephrology · 2019Article
- Phosphate binding by sucroferric oxyhydroxide ameliorates renal injury in the remnant kidney model.Scientific reports · 2019Article
- Machine Learning to Compare Frequent Medical Problems of African American and Caucasian Diabetic Kidney Patients.Healthcare informatics research · 2017Article
- The role of phosphate in kidney disease.Nature reviews. Nephrology · 2017Review
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Authors and funding
14 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough hyperphosphatemia is deemed a risk factor of the progression of chronic kidney disease (CKD), it remains unclear whether the normal range of serum phosphorus likewise deteriorates CKD. A propensity score analysis was applied to examine the causal effect of the normal range of serum phosphorus on the incidence of end-stage renal disease (ESRD).
methodsA retrospective CKD cohort of 803 participants in a single institution was analyzed. Propensity score was estimated using 22 baseline covariates by multivariate binary logistic regression for the different thresholds of time-averaged phosphorus (TA-P) in the normal range of serum phosphorus incremented by 0.1 mg/dL from 3.3 to 4.5 mg/dL.
resultsThe incidence rate of ESRD was 33.9 per 1,000 person-years over median follow-up of 4.3 years. Total patients showed the mean baseline phosphorus of 3.37 mg/dL and were divided to quartile. The higher quartile was associated with the parameters consistent with the advancement of CKD. A stratified Cox regression showed the highest hazard ratio (HR) at TA-P 3.4 mg/dL (HR 17.60, 95% CI 3.92-78.98) adjusted for baseline covariates such as sex, age, diabetic nephropathy, estimated GFR, serum albumin, Na-Cl, phosphorus, LDL-C and proteinuria. Adjusted HRs remained high up to TA-P 4.2 mg/dL (HR 2.22, 95% CI 1.33-3.71). After propensity score matching conducted at the thresholds of TA-P 3.4, 3.6, 3.8 and 4.0 mg/dL, the higher levels of TA-P showed the higher HRs by Kaplan-Meier analysis (p < 0.05 by stratified log-rank test). The numbers needed to treat were calculated as 3.9 to 5.3 over 5 years.
conclusionsThe propensity score analysis shows that even the normal range of serum phosphorus clearly accelerates CKD progression to ESRD. Our results encourage clinicians to target serum phosphorus to inhibit CKD progression in the manner of 'the lower the better.'
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