ArticleBMJ open2017
Impact of nutritional index on the association between phosphorus concentrations and mortality in haemodialysis patients: a cohort study from dialysis outcomes and practice pattern study in Japan.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Malnutrition and sarcopenia: a combined risk factor for vascular calcification and cardiovascular events in hemodialysis patients.Frontiers in nutrition · 2025Article
- Importance of dialysis specialists in early mortality in elderly hemodialysis patients: a multicenter retrospective cohort study.Scientific reports · 2024Article
- Reduced phosphorus is associated with older age and hypoalbuminemia. Risk factors for all-cause mortality in peritoneal dialysis patients.Frontiers in nutrition · 2023Article
- Emerging cross-talks between chronic kidney disease-mineral and bone disorder (CKD-MBD) and malnutrition-inflammation complex syndrome (MICS) in patients receiving dialysis.Clinical and experimental nephrology · 2022Review
- Relationship between malnutrition and possible sarcopenia in the AWGS 2019 consensus affecting mortality in hemodialysis patients: a prospective cohort study.BMC nephrology · 2021Observational
- Geriatric nutrition risk index is associated with renal progression, cardiovascular events and all-cause mortality in chronic kidney disease.Journal of nephrology · 2020Article
- Prediction model for cardiovascular events or all-cause mortality in incident dialysis patients.PloS one · 2019Article
- Association of serum mineral parameters with mortality in hemodialysis patients: Data from the Korean end-stage renal disease registry.Kidney research and clinical practice · 2018Article
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Authors and funding
4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectivesWhile maintenance of both phosphorus concentration and nutritional status is a major concern in managing haemodialysis patients, the interaction between these parameters is not well understood. The aim of this study was to assess whether or not nutritional index influences the association between phosphorus concentration and all-cause mortality.
designA cohort study.
settingThe Dialysis Outcomes and Practice Pattern Study, which included 99 representative dialysis facilities in Japan between 1997 and 2010.
participantsA total of 6230 adult haemodialysis patients who had spent at least 6 months on haemodialysis. MAIN PREDICTORS: Six categories based on time-averaged factors of the geriatric nutritional risk index (GNRI; the lowest two and highest tertiles) and phosphorus concentration (<3.5, 3.5 to <6 and ≥6 mg/dL). PRIMARY OUTCOME MEASURE: All-cause mortality rate. ANALYSIS: Time-dependent Cox regression adjusting for potential confounders.
resultsDuring the follow-up period (12 294 person-years), we noted 561 deaths (4.6 per 100 person-years), and both high phosphorus concentrations and low-middle GNRI were separately associated with all-cause mortality. The harmful effect of high phosphorus concentrations on all-cause mortality was stronger in patients with high GNRI than in those with low-middle GNRI. On the other hand, the harmful effect of low phosphorus concentrations was stronger in those with low-middle GNRI than in those with high GNRI. Relative excess risk due to interaction (RERI) between high phosphorus concentrations and low-middle GNRI was -0.57, indicating an antagonistic interaction. We also observed a significant statistical multiplicative interaction between phosphorus concentrations and GNRI (p=0.05 by likelihood ratio test).
conclusionsThe association between time-averaged serum phosphorus concentration and all-cause mortality differs across the nutritional index. Accordingly, nutritional index should be considered when the impact of phosphorus concentration on mortality in haemodialysis patients is evaluated.
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