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


Journal Article (Review)

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.

Full Text

Duke Authors

Cited Authors

  • Da, J; Xie, X; Wolf, M; Disthabanchong, S; Wang, J; Zha, Y; Lv, J; Zhang, L; Wang, H

Published Date

  • August 2015

Published In

Volume / Issue

  • 66 / 2

Start / End Page

  • 258 - 265

PubMed ID

  • 25804679

Pubmed Central ID

  • 25804679

Electronic International Standard Serial Number (EISSN)

  • 1523-6838

Digital Object Identifier (DOI)

  • 10.1053/j.ajkd.2015.01.009


  • eng

Conference Location

  • United States