Background
Methods
Study design and participants
Data collection and measurements
Assessment of outcomes
Statistical analysis
Results
Study participants and characteristics
Characteristic a | Serum phosphorus time in range in the first year after PD initiation, months | ||||
---|---|---|---|---|---|
Total | Group 1 (Time in range = 0) | Group 2 (Time in range ≤ 6) | Group 3 (Time in range:>6) | P-value | |
No. of participants | 1915 | 319 | 884 | 712 | |
Age, years | 46.7 ± 13.7 | 45.8 ± 13.8 | 46.8 ± 13.9 | 47.1 ± 13.5 | 0.399 |
Male, n (%) | 1029 (53.7) | 182 (57.1) | 485 (54.9) | 362 (50.8) | 0.119 |
BMI, kg/m2 | 21.8 ± 3.2 | 22.4 ± 3.5 | 21.8 ± 3.1 | 21.6 ± 3.2 | < 0.001 |
Smoking, n (%) | 306 (16.0) | 60 (18.8) | 142 (16.1) | 104 (14.6) | 0.234 |
Alcohol drinking, n (%) | 164 (8.6) | 26 (8.2) | 79 (8.9) | 59 (8.3) | 0.862 |
Diabetes, n (%) | 302 (15.8) | 52 (16.4 | 139 (15.8) | 111 (15.6) | 0.951 |
PD vintage, months | 28 (12–47) | 29 (10–46) | 28 (11–46) | 27 (13–49) | 0.639 |
BP at baseline, mmHg | |||||
SBP | 141.7 ± 21.2 | 144.2 ± 21.9 | 141.1 ± 21.8 | 141.4 ± 20.1 | 0.088 |
DBP | 85.9 ± 12.7 | 87.2 ± 13.6 | 85.6 ± 12.8 | 85.8 ± 12.3 | 0.156 |
Baseline laboratory results | |||||
Blood HGB, g/L | 82.9 ± 19.1 | 81.2 ± 19.6 | 82.1 ± 18.8 | 84.6 ± 19.2 | 0.011 |
Serum creatinine, µmol/L | 981.4 ± 358.5 | 1027.9 ± 402.0 | 994.4 ± 363.7 | 945.6 ± 328.2 | 0.001 |
Serum albumin, g/L | 36.4 ± 5.4 | 35.4 ± 5.5 | 36.2 ± 5.4 | 37.1 ± 5.3 | < 0.001 |
Serum phosphorus, mmol/L | 2.1 ± 0.7 | 2.2 ± 0.7 | 2.1 ± 0.7 | 2.0 ± 0.6 | 0.002 |
Serum calcium, mmol/L | 2.0 ± 0.3 | 2.0 ± 0.3 | 2.0 ± 0.3 | 2.0 ± 0.3 | 0.141 |
LN of iPTH, pg/ml | 5.5 ± 1.1 | 5.5 ± 1.1 | 5.5 ± 1.1 | 5.4 ± 1.1 | 0.080 |
Serum potassium, mmol/L | 4.6 ± 0.8 | 4.6 ± 0.8 | 4.6 ± 0.8 | 4.6 ± 0.8 | 0.813 |
Fasting glucose, mmol/L | 5.7 ± 2.0 | 5.5 ± 1.7 | 5.7 ± 2.0 | 5.7 ± 2.2 | 0.660 |
Baseline PD characteristics | |||||
Dialysate GLUC, % | 1.5 ± 0.1 | 1.6 ± 0.2 | 1.5 ± 0.2 | 1.5 ± 0.1 | 0.084 |
UF volume, ml/24 h | 310 (200–500) | 350 (250–530) | 350 (200–500) | 300 (150–500) | 0.002 |
Urine volume, ml/24 h | 1000 (600–1200) | 800 (500–1100) | 1000 (600–1200) | 1000 (694–1250) | < 0.001 |
Mean values of total Kt/V score b | 2.2 ± 0.6 | 2.1 ± 0.7 | 2.2 ± 0.6 | 2.3 ± 0.6 | < 0.001 |
Medication use, n (%) | |||||
Phosphate-binding | 1223 (64.0) | 215 (67.6) | 576 (65.3) | 432 (60.7) | 0.053 |
RASi (ACEI or ARB) | 1476 (77.2) | 231 (72.6) | 670 (75.9) | 575 (80.9) | 0.006 |
Association between serum phosphorus time in range in the first year and risk of clinical outcomes
Serum phosphorus time in range in the first PD year | N | Events, N (%) | Crude Model a | Adjusted Model b | ||
---|---|---|---|---|---|---|
HR (95%CI) | P-Value | aHR (95%CI) | P-Value | |||
All-cause mortality | ||||||
Continuous, per 3 months | 1915 | 249 (13.0) | 0.82 (0.74, 0.90) | < 0.001 | 0.83 (0.75, 0.92) | < 0.001 |
Categories | ||||||
0 month | 319 | 64 (20.1) | Ref. | Ref. | ||
≤ 6 months (median) | 884 | 112 (12.7) | 0.59 (0.43, 0.80) | < 0.001 | 0.53 (0.39, 0.73) | < 0.001 |
> 6 months | 712 | 73 (10.3) | 0.46 (0.33, 0.65) | < 0.001 | 0.50 (0.35, 0.72) | < 0.001 |
CV mortality | ||||||
Continuous, per 3 months | 1915 | 172 (9.0) | 0.83 (0.74, 0.93) | 0.002 | 0.87 (0.77, 0.99) | 0.029 |
Categories | ||||||
0 month | 319 | 42 (13.2) | Ref. | Ref. | ||
≤ 6 months (median) | 884 | 79 (8.9) | 0.64 (0.44, 0.93) | 0.018 | 0.60 (0.41, 0.89) | 0.011 |
> 6 months | 712 | 51 (7.2) | 0.49 (0.33, 0.74) | < 0.001 | 0.58 (0.38, 0.90) | 0.016 |
PD withdrawal c | ||||||
Continuous, per 3 months | 1915 | 527 (27.5) | 0.86 (0.81, 0.92) | < 0.001 | 0.89 (0.83, 0.95) | < 0.001 |
Categories | ||||||
0 month | 319 | 119 (37.3) | Ref. | Ref. | ||
≤ 6 months (median) | 884 | 247 (27.9) | 0.70 (0.56, 0.87) | 0.001 | 0.71 (0.57, 0.89) | 0.003 |
> 6 months | 712 | 161 (22.6) | 0.55 (0.43, 0.70) | < 0.001 | 0.62 (0.49, 0.80) | < 0.001 |