Relationship Between Urinary Phosphate and All-Cause and Cardiovascular Mortality in a National Population-Based Longitudinal Cohort Study

被引:3
|
作者
Toussaint, Nigel D. [1 ,2 ]
Damasiewicz, Matthew J. [3 ,4 ]
Holt, Stephen G. [1 ,2 ]
Lu, Zhong X. [4 ,5 ]
Magliano, Dianna J. [6 ,7 ]
Atkins, Robert C. [6 ]
Chadban, Steven J. [8 ,9 ]
Shaw, Jonathan E. [6 ]
Polkinghorne, Kevan R. [3 ,4 ,7 ]
机构
[1] Royal Melbourne Hosp, Dept Nephrol, Grattan St, Parkville, Vic 3052, Australia
[2] Univ Melbourne, Dept Med, Parkville, Vic, Australia
[3] Monash Hlth, Dept Nephrol, Clayton, Vic, Australia
[4] Monash Univ, Dept Med, Clayton, Vic, Australia
[5] Monash Hlth, Monash Pathol, Melbourne, Vic, Australia
[6] Baker Heart & Diabet Inst, Melbourne, Vic, Australia
[7] Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia
[8] Royal Prince Alfred Hosp, Dept Nephrol & Transplantat, Sydney, NSW, Australia
[9] Univ Sydney, Sydney, NSW, Australia
基金
英国医学研究理事会;
关键词
cardiovascular disease; chronic kidney disease; dietary phosphate; mineral metabolism; mortality; phosphate; urinary phosphate excretion; CHRONIC KIDNEY-DISEASE; DIETARY PHOSPHORUS INTAKE; HIGH-PROTEIN-DIET; SERUM PHOSPHORUS; LIFE-STYLE; CALCIUM; OBESITY; RISK; TARGET; ATHEROSCLEROSIS;
D O I
10.1053/j.jrn.2021.10.009
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
Objectives: High dietary phosphate intake may lead to adverse outcomes including cardiovascular disease (CVD). Urinary phosphate excretion, a marker of intestinal phosphate absorption, may be a more reliable marker of phosphate homeostasis in steady state than serum phosphate. Studies report good agreement between urine phosphate-to-creatinine ratio (uPiCr) and 24-hour urinary phosphate; however, whether uPiCr is associated with increased risk of CVD or mortality remains uncertain. This study aimed to assess the relationship between uPiCr and all-cause and CVD mortality. Design and Methods: This is an observational longitudinal cohort study using data from the population-based national Australian Diabetes, Obesity and Lifestyle study (n = 10,014 participants). Non-linear association between uPiCr and all-cause and CVD mortality was assessed using fractional polynomial transformations. Cox proportional hazards regression models were used to estimate adjusted hazard ratios for all-cause and CVD mortality. Results: Median age [interquartile range] was 50 [41-62] years, and 46% were male. Median uPiCr was 1.38 [1.02-1.79] mmol/mmol. Median follow-up time was 16.9 years with 1,735 deaths. uPiCr was associated with all-cause and CVD mortality in univariate models and when adjusted for age and gender. However, associations were not significant in multivariate models. Sensitivity analyses excluding participants with chronic kidney disease (CKD) revealed a significant J-shaped association between uPiCr and all-cause mortality. Urine phosphate alone showed an association with increased all-cause mortality in a similar J-shape relationship. Conclusion: Although no association between uPiCr and all-cause and CVD mortality was observed in multivariate analyses in the whole cohort, a significant relationship between uPiCr and mortality in those without CKD suggests that uPiCr may have predictive validity for future adverse outcomes in people with no CKD.
引用
收藏
页码:510 / 519
页数:10
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