SAN DIEGO—Elevated serum phosphate levels are independently associated with an increased risk of death among patients with chronic kidney disease (CKD), according to the findings of a meta-analysis presented at Kidney Week.

The meta-analysis focused on 5 prospective cohort studies involving 6,536 patients with CKD stage 3 or 4. All studies assessed the effects of high serum phosphate compared with normal levels and a 1-mg/dL increase in phosphate level in patients with CKD (estimated glomerular filtration rate below 60 mL/min/1.73 m2). The researchers, Anawin Sanguankeo, MD, of the Columbia Unversity College of Physicians and Surgeons in New York, and Sikarin Upala, MD, of Siriraj Hospital in Bangkok, Thailand, excluded patients with end-stage renal disease (ESRD), dialysis patients, and renal transplant patients.

High serum phosphate levels were associated with a significant 36% increased risk of all-cause mortality compared with normal levels, the investigators reported. Each 1-mg/dL increment in serum phosphate was associated with a significant 23% increased risk of all-cause mortality.


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Drs. Sanguankeo and Upala concluded that randomized controlled trials are needed to evaluate the benefit of using phosphate-lowering therapy in CKD patients before they progress to ESRD or dialysis.