Association of Serum Phosphate Levels with Chronic Kidney Disease Progression: The Fukuoka Kidney Disease Registry Study

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Association of Serum Phosphate Levels with Chronic Kidney Disease Progression: The Fukuoka Kidney Disease Registry Study

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Co-author 1

Yurina Takanami takanami.yurina.323@s.kyushu-u.ac.jp Kyushu University Department of Medicine and Clinical Science, Graduate School of Medical Sciences Fukuoka Japan *

Co-author 2

Shunsuke Yamada ana65641@nifty.com Kyushu University Department of Medicine and Clinical Science, Graduate School of Medical Sciences Fukuoka Japan -

Co-author 3

Shigeru Tanaka tanaka.shigeru.170@m.kyushu-u.ac.jp Kyushu University Department of Medicine and Clinical Science, Graduate School of Medical Sciences Fukuoka Japan -

Co-author 4

Kazuhiro Okamura okamurasjp2008@gmail.com Kyushu University Department of Medicine and Clinical Science, Graduate School of Medical Sciences Fukuoka Japan -

Co-author 5

Hiromasa Kitamura ktmrhrmssmrhrmtk@yahoo.co.jp Kyushu University Department of Medicine and Clinical Science, Graduate School of Medical Sciences Fukuoka Japan -

Co-author 6

Kazuhiko Tsuruya tsuruya@naramed-u.ac.jp Nara Medical University Department of Nephrology Nara Japan -

Co-author 7

Tetsuro Ago ago.tetsuro.544@m.kyushu-u.ac.jp Kyushu University Department of Medicine and Clinical Science, Graduate School of Medical Sciences Fukuoka Japan -

Co-author 8

Toshiaki Nakano nakano.toshiaki.455@m.kyushu-u.ac.jp Kyushu University Department of Medicine and Clinical Science, Graduate School of Medical Sciences Fukuoka Japan -

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

While a higher serum phosphate level is a well-established risk factor for poor outcomes in dialysis patients, its impact in patients with chronic kidney disease (CKD) who are not on dialysis remains underexplored. This study aimed to clarify the association between serum phosphate levels and the risk of CKD progression in Japanese patients with CKD not on dialysis.

Methods

A total of 4,088 Japanese non-dialysis CKD patients aged ≥18 years enrolled in the Fukuoka Kidney disease Registry (FKR) Study were prospectively followed for 5 years. Patients were categorized into quartiles according to serum phosphate (P) levels (mg/dL) (Q1: < 3.0, Q2: 3.0 ≤ P < 3.4, Q3: 3.4 ≤ P < 3.9, Q4: ≥ 3.9). The association between serum phosphate levels and the risk of a composite kidney event, defined as progression to end-stage kidney disease or a 1.5-fold increase in serum creatinine, was examined using Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusted for potential confounders.

Results

During the 5-year observation period, 1406 patients developed the composite kidney event. After multivariable adjustment, compared to the lowest serum phosphate levels quartile (Q1), patients in the highest quartile (Q4) had an increased risk of the composite kidney event (HR 1.40, 95% CI 1.17–1.67, p < 0.001). There was a significant dose-response relationship across the quartiles (p for trend < 0.001). In a subgroup analysis stratified by median body mass index (BMI), a significant interaction was observed (p for interaction = 0.039), with the association between higher phosphate levels and adverse kidney outcomes being more pronounced in patients with a lower BMI (< 22.87 kg/m²).

Conclusion

Higher serum phosphate levels are independently associated with an increased risk of CKD progression.

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