Phosphorus as an early marker of morbidity and mortality in type 2 chronic kidney disease diabetic patients

Aims: To evaluate the association of different phosphorus levels with cardiovascular mortality and hospitalizations risk in type-2 diabetic patients in phase 3/4 of CKD. Methods: An observational, prospective study involving 119 patients divided into groups according to baseline phosphorus levels: 1, <= 3.60 mg/dL; 2, 3.60-4.60 mg/dL; and 3, >4.60 mg/dL. Baseline characteristics were analyzed and compared. Multivariate Cox regression and Multivariate Logistic regression were used to find out the predictors of cardiovascular mortality and hospitalizations, respectively. T-test was used to investigate the association of phosphorus and start of hemodialysis. Results: Patients of group 3 presented lower clearance and Hb and increased PTH, CaxP, LVMI, HOMA, uric acid, IL-6 and more hospitalization days. Patients' mean survival on groups 1, 2 and 3 was 62.5 +/- 1.95, 60.1 +/- 2.85 and 52.6 +/- 2.84 months, respectively (p = 0.001). Phosphorus and creatinine levels were independent predictors of mortality, and phosphorus, creatinine, PTH and age were independent predictors of hospitalizations in this population. Patients who entered hemodialysis presented greater phosphorus levels than those who did not (5.04 +/- 1.31 vs. 4.14 +/- 1.09; p = 0.001). Conclusions: Phosphorus was a predictor of cardiovascular mortality and hospitalizations. Phosphorus levels might have a significant clinical use, possibly translated as an early marker of mortality and hospitalizations in this population. (C) 2013 Elsevier Inc. All rights reserved.