Exploring the Impact of Serum Phosphate Levels and Hyperphosphatemia on Renal Outcomes: A Real-World Evidence Study
Author(s)
Ishfaq Rashid Teali, Sr., PhD1, Pramil Tiwari, PhD2, Sanjay D'cruz, MBBS, MD, DM3, Shivani Jaswal, MBBS, MD3;
1University of Utah, Postdoctoral Fellow, Salt Lake City, UT, USA, 2National Institute of Pharmaceutical Education and Research, Mohali, India, 3Government Medical College and Hospital, Chandigarh, Chandigarh, India
1University of Utah, Postdoctoral Fellow, Salt Lake City, UT, USA, 2National Institute of Pharmaceutical Education and Research, Mohali, India, 3Government Medical College and Hospital, Chandigarh, Chandigarh, India
Presentation Documents
OBJECTIVES: Hyperphosphatemia and elevated serum phosphate levels have been implicated in the progression of chronic kidney disease (CKD). This study aimed to explore the impact of serum phosphate levels and hyperphosphatemia on renal outcomes in CKD patients.
METHODS: A prospective real-world evidence study was conducted with 360 CKD patients, followed for a median of 14±4.24 months. This study analyzed the relationship between serum phosphate quartiles (Q1 to Q4) and renal outcomes, including mortality, composite endpoints (dialysis initiation, ESRD progression, doubling of serum creatinine), and adverse renal events. Survival analysis was conducted using Kaplan-Meier curves, Log-rank test, and Cox proportional hazards models to evaluate associations. Statistical significance was defined as p<0.05, using STATA.
RESULTS: Mortality rates significantly increased across quartiles, with the highest rate observed in Q4 (26.4%). The incidence of composite endpoints also rose significantly from 20.4% in Q1 to 64.4% in Q4. Dialysis initiation was most prevalent in Q4 (43.7%), and both ESRD progression and serum creatinine doubling exhibited similar upward trends. Cox proportional hazards regression revealed a significant association between serum phosphate quartiles and mortality, with Q4 exhibiting over a threefold increased hazard of mortality (HR = 3.29, CI 95% 1.51-7.16, p=0.003) and composite endpoints (HR = 3.59, CI 95% 2.15-5.99, p<0.005). When serum phosphate was modeled as a continuous variable, a 20% increased hazard of mortality (HR = 1.20, CI 95% 1.05-1.37, p=0.005) and a 20% increased hazard for composite endpoints (HR = 1.20, CI 95% 1.11-1.30, p<0.005) were observed. Hyperphosphatemia was an independent predictor of both mortality (HR = 2.59, CI 95% 1.47-4.57, p=0.001) and composite endpoints (HR = 2.55, CI 95% 1.80-3.60, p<0.0005).
CONCLUSIONS: Elevated serum phosphate levels and hyperphosphatemia significantly increase the risk of mortality and composite endpoints in CKD patients. Monitoring and managing phosphate levels may be crucial for reducing CKD progression and improving patient survival outcomes.
METHODS: A prospective real-world evidence study was conducted with 360 CKD patients, followed for a median of 14±4.24 months. This study analyzed the relationship between serum phosphate quartiles (Q1 to Q4) and renal outcomes, including mortality, composite endpoints (dialysis initiation, ESRD progression, doubling of serum creatinine), and adverse renal events. Survival analysis was conducted using Kaplan-Meier curves, Log-rank test, and Cox proportional hazards models to evaluate associations. Statistical significance was defined as p<0.05, using STATA.
RESULTS: Mortality rates significantly increased across quartiles, with the highest rate observed in Q4 (26.4%). The incidence of composite endpoints also rose significantly from 20.4% in Q1 to 64.4% in Q4. Dialysis initiation was most prevalent in Q4 (43.7%), and both ESRD progression and serum creatinine doubling exhibited similar upward trends. Cox proportional hazards regression revealed a significant association between serum phosphate quartiles and mortality, with Q4 exhibiting over a threefold increased hazard of mortality (HR = 3.29, CI 95% 1.51-7.16, p=0.003) and composite endpoints (HR = 3.59, CI 95% 2.15-5.99, p<0.005). When serum phosphate was modeled as a continuous variable, a 20% increased hazard of mortality (HR = 1.20, CI 95% 1.05-1.37, p=0.005) and a 20% increased hazard for composite endpoints (HR = 1.20, CI 95% 1.11-1.30, p<0.005) were observed. Hyperphosphatemia was an independent predictor of both mortality (HR = 2.59, CI 95% 1.47-4.57, p=0.001) and composite endpoints (HR = 2.55, CI 95% 1.80-3.60, p<0.0005).
CONCLUSIONS: Elevated serum phosphate levels and hyperphosphatemia significantly increase the risk of mortality and composite endpoints in CKD patients. Monitoring and managing phosphate levels may be crucial for reducing CKD progression and improving patient survival outcomes.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO103
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Urinary/Kidney Disorders