Reduced phosphorus is associated with older age and hypoalbuminemia. Risk factors for all-cause mortality in peritoneal dialysis patients

Marcela Ávila; Ma Del Carmen Prado; Miguel Ángel Cuevas-Budhart; Ramón Paniagua

doi:10.3389/fnut.2023.1094256

Reduced phosphorus is associated with older age and hypoalbuminemia. Risk factors for all-cause mortality in peritoneal dialysis patients

Front Nutr. 2023 Jul 11:10:1094256. doi: 10.3389/fnut.2023.1094256. eCollection 2023.

Authors

Marcela Ávila¹, Ma Del Carmen Prado¹, Miguel Ángel Cuevas-Budhart¹, Ramón Paniagua¹

Affiliation

¹ Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico.

Abstract

Introduction/aim: Hyperphosphatemia is a mortality risk factor in dialysis patients; however, low phosphorus levels too. Diabetes and malnutrition are strongly associated with mortality and with reduced serum phosphorus. This study analyzed the pattern of serum phosphorus in patients on Peritoneal Dialysis (PD) and its association with mortality.

Methods: A Secondary analysis was performed on a multicenter cohort study in peritoneal dialysis patients from two previous studies done by our group.

Results: Six hundred fifty-four patients were included. Serum phosphorus was <3.6 mg/dL in 28.29% of patients, 3.6 to 5.2 mg/dL in 48.16%, and >5.2 mg/dL in 23.55%. In logistic regression analysis; education, age, and hypoalbuminemia were risk factors for low P levels. In multivariate Cox analysis P < 3.6 mg/dL, age, and low albumin were predictors for all-cause mortality. When lower P and lower albumin were combined, this group had the highest risk for all cause and cardiovascular mortality.

Conclusion: The frequency of patients with reduced serum phosphorus was higher in the Mexican population than in Europe or Asia. Low serum phosphorus levels, older age and hypoalbuminemia were risk factors for all-cause mortality. Low phosphorus combined with low albumin levels were the highest risk factor for all-cause and cardiovascular mortality.

Keywords: all-cause mortality; cardiovascular mortality; diabetes; low serum phosphorus; malnutrition; peritoneal dialysis; reduced phosphorus.

Grants and funding

The authors declare that this study received funding from Sanofi, grant DIREGL07952, and administered by the Fundation IMSS, A.C. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.