Abstract
Hyperphosphatemia has been associated with adverse outcomes in patients with end stage kidney disease (ESKD). The purpose of this study was to determine risk factors for hyperphosphatemia in ESKD patients treated with peritoneal dialysis (PD). This information will be used to develop a patient specific phosphate binder application to facilitate patient self-management of serum phosphate. Adult PD patients documented their food, beverage, and phosphate binder intake for three days using a dietitian developed food journal. Phosphate content of meals was calculated using the ESHA Food Processor SQL Software (ESHA Research, Salem, UT, USA). Clinic biochemistry tests and an adequacy assessment (Baxter Adequest program) were done. Univariate logistic regression was used to determine predictors of serum phosphate >1.78 mmol/L. A multivariable logistic regression model was then fit including those variables that achieved a significance level of p < 0.20 in univariate analyses. Sixty patients (38 men, 22 women) completed the protocol; they were 60 ± 17 years old, 50% had a history of diabetes mellitus (DM) and 33% had hyperphosphatemia (PO4 > 1.78 mmol/L). In univariate analysis, the variables associated with an increased risk of hyperphosphatemia with a p-value < 0.2 were male gender (p = 0.13), younger age (0.07), presence of DM (0.005), higher dose of calcium carbonate (0.08), higher parathyroid serum concentration (0.08), lower phosphate intake (0.03), lower measured glomerular filtration rate (0.15), higher phosphate excretion (0.11), and a higher body mass index (0.15). After multivariable logistic regression analysis, younger age (odds ratio (OR) 0.023 per decade, 95% confidence interval (CI) 0.00065 to 0.455; p = 0.012), presence of diabetes (OR 11.40, 95 CI 2.82 to 61.55; p = 0.0003), and measured GFR (OR 0.052 per mL/min decrease; 95% CI 0.0025 to 0.66) were associated with hyperphosphatemia. Our results support that younger age and diabetes mellitus are significant risk factors for hyperphosphatemia. These findings warrant further investigation to determine the potential mechanisms that predispose younger patients and those with DM to hyperphosphatemia.
Highlights
Hyperphosphatemia is associated with adverse outcomes in patients with end stage kidney disease (ESKD) including abnormal bone and mineral metabolism, vascular and soft tissue calcification, Nutrients 2017, 9, 152; doi:10.3390/nu9020152 www.mdpi.com/journal/nutrientsNutrients 2017, 9, 152 and cardiovascular morbidity and mortality [1,2,3,4,5,6]
English or French speaking/writing adult patients who had ESKD treated with peritoneal dialysis and were taking phosphate binder therapy were eligible for participation
Twenty-two patients were not eligible
Summary
Hyperphosphatemia is associated with adverse outcomes in patients with end stage kidney disease (ESKD) including abnormal bone and mineral metabolism, vascular and soft tissue calcification, Nutrients 2017, 9, 152; doi:10.3390/nu9020152 www.mdpi.com/journal/nutrientsNutrients 2017, 9, 152 and cardiovascular morbidity and mortality [1,2,3,4,5,6]. Hyperphosphatemia is associated with adverse outcomes in patients with end stage kidney disease (ESKD) including abnormal bone and mineral metabolism, vascular and soft tissue calcification, Nutrients 2017, 9, 152; doi:10.3390/nu9020152 www.mdpi.com/journal/nutrients. In an attempt to mitigate this risk, it has been recommended that, when patients have high serum phosphate, that it be lowered towards the normal range but many patients fail to achieve this goal [5,7,8,9,10]. The interventions to control serum phosphate include adequate dialysis, dietary phosphate restriction, and phosphate-binding agents. The most common dialysis prescriptions provide inadequate phosphorous removal alone such that almost all nutritionally replete patients will be in a positive phosphate balance [11]. Nutritional interventions aim to limit the amount of dietary phosphate to less than 1100 mg per day [7]. Not all phosphate is bioavailable as phosphate salts are much more readily absorbed than the phosphate contained in phytic acid [12]
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