Urinary Phosphorus Excretion and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease: The KNOW-CKD Study
The relationship between 24-h urinary phosphorus excretion (24 h UPE) and cardiovascular disease in patients with pre-dialysis chronic kidney disease (CKD) has rarely been studied, despite the fact that the relationship between serum phosphorus level and the risk of a cardiovascular event is well es...
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MDPI AG
2023-05-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/15/10/2267 |
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| author | Sang Heon Suh Tae Ryom Oh Hong Sang Choi Chang Seong Kim Eun Hui Bae Seong Kwon Ma Kook-Hwan Oh Young Youl Hyun Suah Sung Soo Wan Kim |
| author_facet | Sang Heon Suh Tae Ryom Oh Hong Sang Choi Chang Seong Kim Eun Hui Bae Seong Kwon Ma Kook-Hwan Oh Young Youl Hyun Suah Sung Soo Wan Kim |
| author_sort | Sang Heon Suh |
| collection | DOAJ |
| description | The relationship between 24-h urinary phosphorus excretion (24 h UPE) and cardiovascular disease in patients with pre-dialysis chronic kidney disease (CKD) has rarely been studied, despite the fact that the relationship between serum phosphorus level and the risk of a cardiovascular event is well established. A total of 1701 patients with pre-dialysis CKD were finally included for the analyses and were divided into tertiles by 24 h UPE (first tertile (T1, 349.557 (mean) ± 88.413 (standard deviation)), second tertile (T2, 557.530 ± 50.738), and third tertile (T3, 851.695 ± 171.593). The study outcome was a six-point major adverse cardiac event (MACE). The median follow-up duration was 7.992 years. Kaplan–Meier curve analysis visualized that the cumulative incidences of a six-point MACE (<i>p</i> = 0.029) significantly differed from 24 h UPE levels, as the incidence rate of the study outcomes was highest in T1 and lowest in T3. Cox proportional hazard models unveiled that, compared to T1, the risk of a six-point MACE was significantly decreased in T3 (adjusted hazard ratio (HR) 0.376, 95% confidence interval (CI) 0.207 to 0.683). The restricted cubic spline curve analysis visualized an inverted S-shaped association between 24 h UPE level and the risk of a six-point MACE, indicating a significantly increased risk of a six-point MACE in patients with a low 24 h UPE level. In conclusion, low 24 h UPE is associated with adverse cardiovascular outcomes in patients with CKD. Our finding emphasizes that low 24 h UPE should not be a reliable marker for dietary restriction of phosphorus that essentially leads to better outcomes in patients with CKD. |
| first_indexed | 2024-03-11T03:26:03Z |
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| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-11T03:26:03Z |
| publishDate | 2023-05-01 |
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| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-09a864a2f46e47be86f7285cd0941c6e2023-11-18T02:43:59ZengMDPI AGNutrients2072-66432023-05-011510226710.3390/nu15102267Urinary Phosphorus Excretion and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease: The KNOW-CKD StudySang Heon Suh0Tae Ryom Oh1Hong Sang Choi2Chang Seong Kim3Eun Hui Bae4Seong Kwon Ma5Kook-Hwan Oh6Young Youl Hyun7Suah Sung8Soo Wan Kim9Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of KoreaDepartment of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of KoreaDepartment of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of KoreaDepartment of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of KoreaDepartment of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of KoreaDepartment of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of KoreaDepartment of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of KoreaDepartment of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of KoreaDepartment of Internal Medicine, Eulji Medical Center, Eulji University, Seoul 01830, Republic of KoreaDepartment of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of KoreaThe relationship between 24-h urinary phosphorus excretion (24 h UPE) and cardiovascular disease in patients with pre-dialysis chronic kidney disease (CKD) has rarely been studied, despite the fact that the relationship between serum phosphorus level and the risk of a cardiovascular event is well established. A total of 1701 patients with pre-dialysis CKD were finally included for the analyses and were divided into tertiles by 24 h UPE (first tertile (T1, 349.557 (mean) ± 88.413 (standard deviation)), second tertile (T2, 557.530 ± 50.738), and third tertile (T3, 851.695 ± 171.593). The study outcome was a six-point major adverse cardiac event (MACE). The median follow-up duration was 7.992 years. Kaplan–Meier curve analysis visualized that the cumulative incidences of a six-point MACE (<i>p</i> = 0.029) significantly differed from 24 h UPE levels, as the incidence rate of the study outcomes was highest in T1 and lowest in T3. Cox proportional hazard models unveiled that, compared to T1, the risk of a six-point MACE was significantly decreased in T3 (adjusted hazard ratio (HR) 0.376, 95% confidence interval (CI) 0.207 to 0.683). The restricted cubic spline curve analysis visualized an inverted S-shaped association between 24 h UPE level and the risk of a six-point MACE, indicating a significantly increased risk of a six-point MACE in patients with a low 24 h UPE level. In conclusion, low 24 h UPE is associated with adverse cardiovascular outcomes in patients with CKD. Our finding emphasizes that low 24 h UPE should not be a reliable marker for dietary restriction of phosphorus that essentially leads to better outcomes in patients with CKD.https://www.mdpi.com/2072-6643/15/10/226724 h urinecardiovascular outcomechronic kidney diseasemajor adverse cardiac eventphosphorus |
| spellingShingle | Sang Heon Suh Tae Ryom Oh Hong Sang Choi Chang Seong Kim Eun Hui Bae Seong Kwon Ma Kook-Hwan Oh Young Youl Hyun Suah Sung Soo Wan Kim Urinary Phosphorus Excretion and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease: The KNOW-CKD Study Nutrients 24 h urine cardiovascular outcome chronic kidney disease major adverse cardiac event phosphorus |
| title | Urinary Phosphorus Excretion and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease: The KNOW-CKD Study |
| title_full | Urinary Phosphorus Excretion and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease: The KNOW-CKD Study |
| title_fullStr | Urinary Phosphorus Excretion and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease: The KNOW-CKD Study |
| title_full_unstemmed | Urinary Phosphorus Excretion and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease: The KNOW-CKD Study |
| title_short | Urinary Phosphorus Excretion and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease: The KNOW-CKD Study |
| title_sort | urinary phosphorus excretion and cardiovascular outcomes in patients with pre dialysis chronic kidney disease the know ckd study |
| topic | 24 h urine cardiovascular outcome chronic kidney disease major adverse cardiac event phosphorus |
| url | https://www.mdpi.com/2072-6643/15/10/2267 |
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