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Open AccessArticle

Fractional Excretion of Phosphate (FeP) Is Associated with End-Stage Renal Disease Patients with CKD 3b and 5

Department of Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
Nefrology and Dialysis, Ospedale del Mare, ASL Napoli 1 Centro, 80147 Napoli, Italy
Department of Nephrology, School of Medicine, University “FEDERICO II”, 80131 Napoli, Italy
Nefrology and Dialysis, AORN “San Giuseppe Moscati”, 83100 Avellino, Italy
Data Scientist, Cardarelli’s Nephrology Consultant, 83100 Avellino, Italy
Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy
Department of Nephrology and Dialysis, Ospedale Parodi, Delfino, 00034 Colleferro (Rome), Italy
Nephrology and Dialysis, AORN “Antonio Cardarelli”, 80131 Napoli, Italy
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(7), 1026;
Received: 26 May 2019 / Revised: 7 July 2019 / Accepted: 9 July 2019 / Published: 12 July 2019
Background: The perturbation of phosphate homeostasis portends unfavorable outcomes in chronic kidney disease (CKD). However, the absence of randomized clinical trials (RCT) fuels the discussion of whether phosphate or some other phosphorous-related factor(s) such as fibroblast growth factor 23 (FGF-23) mediates the cardiovascular and systemic toxicity. We herein test whether the fractional excretion of phosphate (FeP) as a marker of renal stress to excrete phosphorous predicts unfavorable outcomes in CKD patients. Methods: Retrospective, cross-sectional observational study. For current analysis, an historical cohort of 407 records of CKD stage 3b-5 patients attending between January 2010 and October 2015 at the Nephrology Unit of Solofra (AV), Italy were utilized. Demographic, clinical, laboratory, and outcome data were identified through the subjects’ medical records. We tested whether quartiles of FeP are associated with the risk of CKD progression or all causes of death. Parametric as well as non-parametric tests, linear and logistic regression, as well as survival analysis were utilized. Results: Overall, we investigated middle-age (mean 66.0, standard deviation 12.3 years) men and women (male 43%) with CKD stage 3b to 5 (creatinine clearance 32.0 (13.3) mL/min). Older age, lower diastolic blood pressure, poor renal function, as well as higher serum phosphate were associated with FeP. Patients with higher FeP were at an increased risk of starting dialysis or dying (hazard ratio 2.40; 95% confidence interval (1.44, 3.99)). Notably, when the two endpoints were analyzed separately, FeP was associated with renal but not all-cause survival. Conclusion: FeP is associated with ESRD, but not all-cause mortality risk in a large cohort of moderate to advanced CKD patients. Future efforts are required to validate FeP as a marker of nephron stress and risk factor for CKD progression in this high-risk population. View Full-Text
Keywords: phosphate; phosphate balance; CKD–MBD; outcome; fractional excretion of phosphate; FeP phosphate; phosphate balance; CKD–MBD; outcome; fractional excretion of phosphate; FeP
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Bellasi, A.; Di Micco, L.; Russo, D.; De Simone, E.; Di Iorio, M.; Vigilante, R.; Di Lullo, L.; Di Iorio, B.R. Fractional Excretion of Phosphate (FeP) Is Associated with End-Stage Renal Disease Patients with CKD 3b and 5. J. Clin. Med. 2019, 8, 1026.

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