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Urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study

BACKGROUND: Whether phosphate itself has nephrotoxicity in patients with chronic kidney disease (CKD) is controversial, although phosphate excretion into urine may cause tubular damage in rat models. To evaluate actual phosphate load on each nephron, we examined the association between 24-h urinary...

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Autores principales: Kawasaki, Tomoki, Maeda, Yoshitaka, Matsuki, Hisazumi, Matsumoto, Yuko, Akazawa, Masanobu, Kuyama, Tamaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517498/
https://www.ncbi.nlm.nih.gov/pubmed/26215643
http://dx.doi.org/10.1186/s12882-015-0118-1
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author Kawasaki, Tomoki
Maeda, Yoshitaka
Matsuki, Hisazumi
Matsumoto, Yuko
Akazawa, Masanobu
Kuyama, Tamaki
author_facet Kawasaki, Tomoki
Maeda, Yoshitaka
Matsuki, Hisazumi
Matsumoto, Yuko
Akazawa, Masanobu
Kuyama, Tamaki
author_sort Kawasaki, Tomoki
collection PubMed
description BACKGROUND: Whether phosphate itself has nephrotoxicity in patients with chronic kidney disease (CKD) is controversial, although phosphate excretion into urine may cause tubular damage in rat models. To evaluate actual phosphate load on each nephron, we examined the association between 24-h urinary phosphorus excretion per creatinine clearance (24-h U-P/C(Cr)), a newly proposed index that is a surrogate for nephron load, and CKD progression in patients with CKD. METHODS: We conducted a single-center, retrospective cohort study. To avoid potential confounders for protein intake, only patients on our educational program for CKD with a fixed diet regimen and aged 20 years or older were included. The observation period was 3 years. Primary outcomes were CKD progression defined as a composite of end-stage kidney disease (ESKD) or 50 % reduction of estimated glomerular filtration rate. Patients were stratified by quartiles of 24-h U-P/C(Cr) levels as Quartiles 1–4. The association was examined in three models: unadjusted (Model 1), adjusted for risk factors for CKD progression (Model 2), and factors that affect renal phosphate handling (Model 3). RESULTS: A total of 191 patients met the eligibility criteria. Patients with higher 24-h U-P/C(Cr) showed a higher risk for the composite outcomes. The hazard ratios [95 % confidence interval] for 24-h U-P/C(Cr) levels in Quartile 2, 3, and 4, respectively, versus Quartile 1 were 2.56 (1.15–6.24), 7.53 (3.63–17.62), and 12.17 (5.82–28.64) in Model 1; 1.66 (0.63–4.97), 3.57 (1.25–11.71), and 5.34 (1.41–22.32) in Model 2; and 3.07 (0.97–11.85), 7.52 (2.13–32.69), and 7.89 (1.74–44.33) in Model 3. CONCLUSIONS: Our study showed that higher phosphorus excretion per creatinine clearance was associated with CKD progression.
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spelling pubmed-45174982015-07-29 Urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study Kawasaki, Tomoki Maeda, Yoshitaka Matsuki, Hisazumi Matsumoto, Yuko Akazawa, Masanobu Kuyama, Tamaki BMC Nephrol Research Article BACKGROUND: Whether phosphate itself has nephrotoxicity in patients with chronic kidney disease (CKD) is controversial, although phosphate excretion into urine may cause tubular damage in rat models. To evaluate actual phosphate load on each nephron, we examined the association between 24-h urinary phosphorus excretion per creatinine clearance (24-h U-P/C(Cr)), a newly proposed index that is a surrogate for nephron load, and CKD progression in patients with CKD. METHODS: We conducted a single-center, retrospective cohort study. To avoid potential confounders for protein intake, only patients on our educational program for CKD with a fixed diet regimen and aged 20 years or older were included. The observation period was 3 years. Primary outcomes were CKD progression defined as a composite of end-stage kidney disease (ESKD) or 50 % reduction of estimated glomerular filtration rate. Patients were stratified by quartiles of 24-h U-P/C(Cr) levels as Quartiles 1–4. The association was examined in three models: unadjusted (Model 1), adjusted for risk factors for CKD progression (Model 2), and factors that affect renal phosphate handling (Model 3). RESULTS: A total of 191 patients met the eligibility criteria. Patients with higher 24-h U-P/C(Cr) showed a higher risk for the composite outcomes. The hazard ratios [95 % confidence interval] for 24-h U-P/C(Cr) levels in Quartile 2, 3, and 4, respectively, versus Quartile 1 were 2.56 (1.15–6.24), 7.53 (3.63–17.62), and 12.17 (5.82–28.64) in Model 1; 1.66 (0.63–4.97), 3.57 (1.25–11.71), and 5.34 (1.41–22.32) in Model 2; and 3.07 (0.97–11.85), 7.52 (2.13–32.69), and 7.89 (1.74–44.33) in Model 3. CONCLUSIONS: Our study showed that higher phosphorus excretion per creatinine clearance was associated with CKD progression. BioMed Central 2015-07-28 /pmc/articles/PMC4517498/ /pubmed/26215643 http://dx.doi.org/10.1186/s12882-015-0118-1 Text en © Kawasaki et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kawasaki, Tomoki
Maeda, Yoshitaka
Matsuki, Hisazumi
Matsumoto, Yuko
Akazawa, Masanobu
Kuyama, Tamaki
Urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study
title Urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study
title_full Urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study
title_fullStr Urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study
title_full_unstemmed Urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study
title_short Urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study
title_sort urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517498/
https://www.ncbi.nlm.nih.gov/pubmed/26215643
http://dx.doi.org/10.1186/s12882-015-0118-1
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