ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2020
Impact of longer term phosphorus control on cardiovascular mortality in hemodialysis patients using an area under the curve approach: results from the DOPPS.
Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers.
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Who cites it
34 citing papers in PubMed, 59 citations in OpenAlex.
- Safety and Phosphate-Binding Capacity of Oxylanthanum Carbonate in Healthy Volunteers.Clinical and translational science · 2025Trial
- Safety and Efficacy of Tenapanor for Long-term Serum Phosphate Control in Maintenance Dialysis: A 52-Week Randomized Phase 3 Trial (PHREEDOM).Kidney360 · 2021Trial
- Validation and Clinical Evaluation of an LC-MS/MS Method for Serum Full-Length Parathyroid Hormone 1-84 with Application to Chronic Kidney Disease.ACS pharmacology & translational science · 2026Article
- Determinants of Intradialytic Phosphate Removal in Hemodiafiltration From Real-World Clinical Practice.Artificial organs · 2026Observational
- The effects of elevated phosphate on the kidney - damaging the gatekeeper.Pflugers Archiv : European journal of physiology · 2026Review
- Four Distinct Dynamic Intracranial Pressure Trajectories and Their Prognostic Implications in Acute Brain Injury: A Multicenter Cohort Study.CNS neuroscience & therapeutics · 2026Article
- The influencing factors of phosphate control behavior among patients undergoing hemodialysis: based on the health belief model.Renal failure · 2025Article
- Tight Phosphate Control in ESKD Patients Is Warranted: PRO.Kidney360 · 2024Article
- Early, Intensive and Persistent Lipid-Lowering Therapy for Secondary Prevention of Acute Coronary Syndrome.Journal of atherosclerosis and thrombosis · 2024Article
- Crosstalk between kidney and bone: insights from CKD-MBD.Journal of bone and mineral metabolism · 2024Review
- Screening for depression in chronic haemodialysis patients as a part of care in dialysis setting: a cross-sectional study.Frontiers in psychiatry · 2024Article
- Assessment of the Correlation Between Serum Phosphate Level and Muscle Strength as Measured by Handgrip Strength in Patients Treated With Hemodialysis.Canadian journal of kidney health and disease · 2024Article
- Time to Shift our Mindset to a Phosphate-Centric Approach for Prevention of Cardiovascular Calcification in the Dialysis Population.Journal of atherosclerosis and thrombosis · 2023Article
- Clinical Implication of Consistently Strict Phosphate Control for Coronary and Valvular Calcification in Incident Patients Undergoing Hemodialysis.Journal of atherosclerosis and thrombosis · 2023Article
- Association between CKD-MBD and mortality in older patients with advanced CKD-results from the EQUAL study.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2023Article
- [Diagnosis and treatment of osteoporosis in patients with chronic kidney disease : Joint guidelines of the Austrian Society for Bone and Mineral Research (ÖGKM), the Austrian Society of Physical and Rehabilitation Medicine (ÖGPMR) and the Austrian Society of Nephrology (ÖGN)].Wiener medizinische Wochenschrift (1946) · 2023Review
- Effect of dialytic phosphate reduction rate on mortality in maintenance hemodialysis patients: a matched case-control study.BMC nephrology · 2023Article
- Bone Mineral Density and Vascular Calcification in Children and Young Adults With CKD 4 to 5 or on Dialysis.Kidney international reports · 2023Article
- Serum Phosphorus Level Rises in US Hemodialysis Patients Over the Past Decade: A DOPPS Special Report.Kidney medicine · 2023Article
- Association of single and serial measures of serum phosphorus with adverse outcomes in patients on peritoneal dialysis: results from the international PDOPPS.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2023Article
Corrections and comments
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Authors and funding
11 authors at 5 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSerial assessment of phosphorus is currently recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, but its additional value versus a single measurement is uncertain.
methodsWe studied data from 17 414 HD patients in the Dialysis Outcomes and Practice Patterns Study, a prospective cohort study, and calculated the area under the curve (AUC) by multiplying the time spent with serum phosphorus >4.5 mg/dL over a 6-month run-in period by the extent to which this threshold was exceeded. We estimated the association between the monthly average AUC and cardiovascular (CV) mortality using Cox regression. We formally assessed whether AUC was a better predictor of CV mortality than other measures of phosphorus control according to the Akaike information criterion.
resultsCompared with the reference group of AUC = 0, the adjusted hazard ratio (HR) of CV mortality was 1.12 [95% confidence interval (CI) 0.90-1.40] for AUC > 0-0.5, 1.26 (95% CI 0.99-1.62) for AUC > 0.5-1, 1.44 (95% CI 1.11-1.86) for AUC > 1-2 and 2.03 (95% CI 1.53-2.69) for AUC > 2. The AUC was predictive of CV mortality within strata of the most recent phosphorus level and had a better model fit than other serial measures of phosphorus control (mean phosphorus, months out of target).
conclusionsWe conclude that worse phosphorus control over a 6-month period was strongly associated with CV mortality. The more phosphorus values do not exceed 4.5 mg/dL the better is survival. Phosphorus AUC is a better predictor of CV death than the single most recent phosphorus level, supporting with real-world data KDIGO's recommendation of serial assessment of phosphorus to guide clinical decisions.
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