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Clinical and Experimental Nephrology

25-09-2024 | Polycystic Kidney Disease | Original article

Association of hyperphosphatemia with renal prognosis in patients with autosomal dominant polycystic kidney disease

Authors: Kosaku Nitta, Hiroshi Kataoka, Shun Manabe, Shiho Makabe, Taro Akihisa, Yusuke Ushio, Momoko Seki, Ken Tsuchiya, Junichi Hoshino, Toshio Mochizuki

Published in: Clinical and Experimental Nephrology

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Abstract

Background

Serum phosphate (P) levels are generally lower in autosomal dominant polycystic kidney disease (ADPKD) than in other kidney disorders, potentially masking the clinical significance of hyperphosphatemia. This study aimed to determine if serum P levels can predict renal outcomes in ADPKD patients.

Methods

We included 235 patients with ADPKD who were not taking drugs to treat hyperphosphatemia. Survival analysis was performed for the renal outcome of a 50% reduction in estimated glomerular filtration rate or initiation of renal replacement therapy.

Results

Multivariable Cox regression analyses revealed that serum P (1 mg/dL increase, HR = 2.03, P < 0.0001) was a significant risk factor for kidney disease progression. Similarly, hyperphosphatemia (P > 3.5 mg/dL, HR = 2.05; P > 4.0 mg/dL, HR = 1.90; P > 4.5 mg/dL, HR = 2.78; P > 5.0 mg/dL, HR = 27.22) was significantly associated with renal prognosis. Kaplan–Meier analysis showed significantly lower kidney survival rates in patients with P > 3.5 mg/dL than in those without hyperphosphatemia (log-rank test, P < 0.0001), and similar Kaplan–Meier analysis results were found for P > 4.0 mg/dL, P > 4.5 mg/dL, and P > 5.0 mg/dL. The 2 year kidney survival rate for ADPKD patients with P > 3.5 mg/dL was 66.7% overall and 41.4% in those with stage 4–5 CKD. For patients with P > 4.0 mg/dL, the survival rate dropped to 46.8% overall and 28.2% in those with stage 4–5 CKD, indicating a very poor prognosis.

Conclusion

Hyperphosphatemia was associated with renal prognosis in patients with ADPKD. In these patients, attention should be paid to even mild serum P elevation of > 3.5 or > 4.0 mg/dL.
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Metadata
Title
Association of hyperphosphatemia with renal prognosis in patients with autosomal dominant polycystic kidney disease
Authors
Kosaku Nitta
Hiroshi Kataoka
Shun Manabe
Shiho Makabe
Taro Akihisa
Yusuke Ushio
Momoko Seki
Ken Tsuchiya
Junichi Hoshino
Toshio Mochizuki
Publication date
25-09-2024
Publisher
Springer Nature Singapore
Published in
Clinical and Experimental Nephrology
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-024-02568-6

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