Reducing Phosphorus Improves Survival

NEW ORLEANS—Dialysis patients with hyperphosphatemia survive longer when serum phosphorus is reduced, Dutch researchers confirmed at Kidney Week 2017.

Marc Vervloet, MD, PhD, of VU University Medical Center in Amsterdam and colleagues examined mortality in 5487 hemodialysis and peritoneal dialysis patients (age 65 years; 61% male) in the Dutch renal replacement registry (RENINE) according to both absolute and relative declines in phosphorus from baseline.

The team confirmed a U-shaped relationship between phosphate and mortality, as previous studies have shown. Achieved phosphorus levels around 1.25 mmol/L were associated with the lowest risk for death. The novel finding is that patients with higher baseline phosphorus reaped the most survival benefit from greater phosphorus decline. Achieving a value of 1.4 mmol/L seemed optimal, regardless of baseline value. Adjusting for calcium and parathyroid hormone did not alter the findings.

“Guidelines recommend treating hyperphosphatemia in chronic kidney disease, but treatment goals are ill-defined so far,” Dr Vervloet told Renal & Urology News. “The analysis of the RENINE cohort demonstrates that patients with higher baseline phosphate benefit from more declined phosphate after 1 year. For all patients, a phosphate goal of 1.4 mmol/L appears optimal. Our data reinforce current clinical practice.”

1. Hoekstra T, van Ittersum Frans J, Hemmelder MH, Vervloet MG. Phosphate and phosphate changes are associated with mortality in Dutch dialysis patients: A registry based analysis. Presented at Kidney Week 2017 in New Orleans (Oct. 31-Nov. 5). Abstract TH-PO1040.