Dietary Phosphorus, Its Sources, and Mortality in Adults on Haemodialysis: The DIET-HD Study
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design
2.2. Study Population
2.3. Dietary Assessment of Phosphorus Intake
2.4. Outcomes
2.5. Statistical Analysis
2.6. Missing Data Handling
2.7. Main Analysis
2.8. Subgroup Analysis
2.9. Sensitivity Analysis
3. Results
3.1. Baseline Characteristics
3.2. Total Phosphorus Intake and Mortality
3.3. Proportion of Phosphorus Intake from Different Sources and Mortality
3.3.1. Plant Sources
3.3.2. Animal Sources
3.3.3. Processed and Other Sources
3.4. Subgroup Analysis
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Overall (n = 8110) | Lowest Tertile (154–1100 mg/Day) (n = 2704) | Middle Tertile (1101–1747 g/Day) (n = 2703) | Highest Tertile (1748–8179 g/day) (n = 2703) | p for Trend |
---|---|---|---|---|---|
Demographics | |||||
Age, years, mean (SD) | 63 (15) | 63 (15) | 64 (15) | 62 (15) | 0.77 |
Women, n (%) | 3419 (42) | 1209 (45) | 1156 (43) | 1054 (39) | <0.01 |
Education: Secondary level or above, n (%) | 2699 (44) | 1158 (43) | 1253 (46) | 1314 (49) | <0.01 |
Never smoker, n (%) | 4212 (67) | 1854 (69) | 1807 (67) | 1796 (66) | 0.1 |
Irregular physical activity or more, n (%) | 3249 (52) | 1391 (51) | 1369 (51) | 1559 (58) | <0.01 |
Never drinking alcohol, n (%) | 4116 (51) | 1455 (54) | 1376 (51) | 1282 (47) | <0.01 |
Body mass index, n (%) | 26 (5) | 26(5) | 26(5) | 26 (6) | 0.9 |
Diet | |||||
Energy intake, kcal/d, median (IQR) | 1900 (1404–2520) | 1260 (992–1552) | 1971 (1682–2286) | 2762 (2228–3450) | <0.01 |
Potassium intake, g/d, median (IQR) | 1388 (961–1994) | 882 (654–961) | 1389 (1243–1557) | 2324(1995–2858) | <0.01 |
Mediterranean score, median (IQR) | 4 (3–5) | 3 (2–4) | 4 (3–5) | 5 (4–6) | <0.01 |
Clinical characteristics | |||||
Weight change in kg (3 months prior), median (IQR) | 0.1 (−0.9–1) | 0.1 (−1–1) | 0.0 (−0.9–1) | 0 (−0.1–1) | 0.45 |
Hypertension, n (%) | 6219 (85) | 2272 (84) | 2323 (86) | 2301 (85) | 0.26 |
Diabetes mellitus, n (%) | 2332 (32) | 834 (31) | 895 (33) | 848 (31) | 0.68 |
Cardiovascular disease, n (%) | 2973 (37) | 880 (33) | 1033 (38) | 1060 (39) | <0.01 |
Chronic pulmonary disease, n (%) | 940 (12) | 276 (10) | 312 (12) | 352 (13) | <0.01 |
Cancer, n (%) | 1045 (13) | 285 (10) | 381 (14) | 379 (14) | <0.01 |
Laboratory variables | |||||
Normalised protein catabolic rate, g/kg/d, median (IQR) | 1.1 (0.9–1.3) | 1.1 (0.9–1.3) | 1.1 (0.9–1.3) | 1.1 (0.9–1.3) | 0.45 |
Serum phosphorus, mg/dl, mean (SD) | 4.7 (1.4) | 4.7 (1.4) | 4.6 (1.4) | 4.8 (1.5) | <0.01 |
Haemoglobin, g/dl, mean (SD) | 11.1 (1.3) | 11.1 (1.3) | 11.1 (1.3) | 11.0 (1.3) | 0.15 |
Albumin, g/l, mean (SD) | 39.8 (3.8) | 39.7 (3.8) | 39.9 (3.7) | 39.8 (3.8) | 0.31 |
Calcium, mg/dl, mean (SD) | 8.9 (0.7) | 8.9 (0.7) | 9.0 (0.7) | 8.9 (0.7) | 0.37 |
Dialysis characteristics | |||||
Arteriovenous fistula, n (%) | 6481 (81) | 2157 (80) | 2168 (80) | 2208 (82) | 0.08 |
Dialysis vintage, years, median (IQR) | 3.6 (1.7–6.8) | 3.8 (1.8–7.1) | 3.6 (1.7–6.8) | 3.5 (1.7–6.5) | 0.19 |
Kt/V, mean (SD) | 1.7 (0.3) | 1.8 (0.4) | 1.8 (0.3) | 1.7 (0.3) | <0.01 |
Medications | |||||
Antihypertensives, n (%) | 6136 (76) | 2039 (75) | 2036 (75) | 2061 (76) | 0.47 |
Phosphate binders, n (%) | 3263 (40) | 895 (33) | 1065 (39) | 1303 (48) | <0.01 |
Statin, n (%) | 2316 (37) | 960 (36) | 1025 (38) | 961 (36) | 0.96 |
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Su, G.; Saglimbene, V.; Wong, G.; Bernier-Jean, A.; Carrero, J.J.; Natale, P.; Ruospo, M.; Hegbrant, J.; Craig, J.C.; Strippoli, G.F.M. Dietary Phosphorus, Its Sources, and Mortality in Adults on Haemodialysis: The DIET-HD Study. Nutrients 2022, 14, 4064. https://doi.org/10.3390/nu14194064
Su G, Saglimbene V, Wong G, Bernier-Jean A, Carrero JJ, Natale P, Ruospo M, Hegbrant J, Craig JC, Strippoli GFM. Dietary Phosphorus, Its Sources, and Mortality in Adults on Haemodialysis: The DIET-HD Study. Nutrients. 2022; 14(19):4064. https://doi.org/10.3390/nu14194064
Chicago/Turabian StyleSu, Guobin, Valeria Saglimbene, Germaine Wong, Amélie Bernier-Jean, Juan Jesus Carrero, Patrizia Natale, Marinella Ruospo, Jorgen Hegbrant, Jonathan C. Craig, and Giovanni F. M. Strippoli. 2022. "Dietary Phosphorus, Its Sources, and Mortality in Adults on Haemodialysis: The DIET-HD Study" Nutrients 14, no. 19: 4064. https://doi.org/10.3390/nu14194064