Chronic Kidney Disease

CKD: Phosphorus (2018)

• Intervention
  What is the effect of dietary phosphorus intake on mortality in adults with CKD 1-5D and post-transplant?

  • Conclusion

    One study reported no significant association between dietary phosphorus intake and mortality risk in CKD pre-dialysis patients, while another study showed higher dietary phosphorus was associated with greater 5-year mortality risk in hemodialysis patients.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of dietary phosphorus intake on mortality in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Murtaugh M, Filipowicz R, Baird B, Wei G, Greene T, Beddhu S. Dietary phosphorus intake and mortality in moderate chronic kidney disease: NHANES III. Nephrology, Dialysis, Transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2012; 27:990-6
      • Noori N, Kalantar-Zadeh K, Kovesdy C, Bross R, Benner D, Kopple J. Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clinical Journal of the American Society of Nephrology 2010; 5:683-92
  • Search Plan and Results: CKD: Electrolytes: Phosphorus (2018)
     
  What is the effect of 24-hour urinary phosphorus/phosphate excretion on mortality in adults with CKD 1-5D and post-transplant?

  • Conclusion

    In CKD pre-dialysis patients, 24-hour urinary phosphorus/phosphate excretion was not significantly associated with mortality risk in two studies.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of 24-hour urinary phosphorus/phosphate excretion on mortality in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Palomino H, Rifkin D, Anderson C, Criqui M, Whooley M, Ix J. 24-hour urine phosphorus excretion and mortality and cardiovascular events. Clinical Journal of the American Society of Nephrology : CJASN 2013; 8:1202-10
      • Selamet U, Tighiouart H, Sarnak M, Beck G, Levey A, Block G, Ix J. Relationship of dietary phosphate intake with risk of end-stage renal disease and mortality in chronic kidney disease stages 3-5: The Modification of Diet in Renal Disease Study. Kidney International 2016; 89:176-84
  • Search Plan and Results: CKD: Electrolytes: Phosphorus (2018)
     
  What is the effect of 24-hour urinary phosphorus/phosphate excretion on cardiovascular events in adults with CKD 1-5D and post-transplant?

  • Conclusion

    In CKD pre-dialysis patients, higher 24-hour urine phosphorus excretion was significantly associated with lower risk of cardiovascular disease events in one study.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of 24-hour urinary phosphorus/phosphate excretion on cardiovascular events in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Palomino H, Rifkin D, Anderson C, Criqui M, Whooley M, Ix J. 24-hour urine phosphorus excretion and mortality and cardiovascular events. Clinical Journal of the American Society of Nephrology : CJASN 2013; 8:1202-10
  • Search Plan and Results: CKD: Electrolytes: Phosphorus (2018)
     
  What is the effect of urinary phosphorus/phosphate excretion per creatinine clearance on CKD progression in adults with CKD 1-5D and post-transplant?

  • Conclusion

    In CKD pre-dialysis patients, greater urinary phosphorus excretion per creatinine clearance was associated with greater CKD progression (e.g., progressed to end-stage renal disease (ESRD) or 50% reduction of eGFR) in one study.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of urinary phosphorus/phosphate excretion per creatinine clearance on CKD progression in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Kawasaki T, Maeda Y, Matsuki H, Matsumoto Y, Akazawa M, Kuyama T. Urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study. BMC Nephrology 2015; 16:116
  • Search Plan and Results: CKD: Electrolytes: Phosphorus (2018)
     
  What is the effect of dietary phosphorus/phosphate restriction on CKD progression in adults with CKD 1-5D and post-transplant?

  • Conclusion

    In pre-dialysis patients, dietary protein and phosphate restriction did not slow the rate of CKD progression (e.g., mean rate of fall of creatinine clearance, plasma creatinine, or distribution of those who improved or worsened) in one study.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of dietary phosphorus/phosphate restriction on CKD progression in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Williams P, Stevens M, Fass G, Irons L, Bone J. Failure of dietary protein and phosphate restriction to retard the rate of progression of chronic renal failure: a prospective, randomized, controlled trial. The Quarterly Journal of Medicine 1991; 81:837-55
  • Search Plan and Results: CKD: Electrolytes: Phosphorus (2018)
     
  What is the effect of 24-hour urinary phosphate excretion on CKD progression in adults with CKD 1-5D and post-transplant?

  • Conclusion

    In CKD pre-dialysis patients, greater 24-hour urinary phosphate excretion was not associated with end-stage renal disease (ESRD) (i.e., progressed to ESRD) in one study.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of 24-hour urinary phosphate excretion on CKD progression in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Selamet U, Tighiouart H, Sarnak M, Beck G, Levey A, Block G, Ix J. Relationship of dietary phosphate intake with risk of end-stage renal disease and mortality in chronic kidney disease stages 3-5: The Modification of Diet in Renal Disease Study. Kidney International 2016; 89:176-84
  • Search Plan and Results: CKD: Electrolytes: Phosphorus (2018)
     
  What is the effect of dietary phosphorus/phosphate restriction on serum phosphorus and urinary phosphorus /phosphate excretion in adults with CKD 1-5D and post-transplant?

  • Conclusion

    Dietary phosphorus/phosphate restriction appeared to reduce serum phosphorus and urinary phosphorus /phosphate excretion among CKD pre-dialysis and hemodialysis patients in all studies but not among post-transplantation patients in one study.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of dietary phosphorus/phosphate restriction on serum phosphorus and urinary phosphorus /phosphate excretion in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ambühl P, Meier D, Wolf B, Dydak U, Boesiger P, Binswanger U. Metabolic aspects of phosphate replacement therapy for hypophosphatemia after renal transplantation: impact on muscular phosphate content, mineral metabolism, and acid/base homeostasis. American Journal of Kidney Diseases : the official journal of the National Kidney Foundation 1999; 34:875-83
      • Lou L, Caverni A, Gimeno J, Moreno R, Pérez J, Alvarez R, Campos B, García M, Gutiérrez A, Bielsa S, Castilla J, Sanz A, Martin F. Dietary intervention focused on phosphate intake in hemodialysis patients with hyperphosphoremia. Clinical Nephrology 2012; 77:476-83
      • Martinez I, Saracho R, Montenegro J, Llach F. The importance of dietary calcium and phosphorous in the secondary hyperparathyroidism of patients with early renal failure. American Journal of Kidney Diseases : the official journal of the National Kidney Foundation 1997; 29:496-502
      • Sigrist M, Tang M, Beaulieu M, Espino-Hernandez G, Er L, Djurdjev O, Levin A. Responsiveness of FGF-23 and mineral metabolism to altered dietary phosphate intake in chronic kidney disease (CKD): results of a randomized trial. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2013; 28:161-9
      • Sullivan C, Sayre S, Leon J, Machekano R, Love T, Porter D, Marbury M, Sehgal A. Effect of Food Additives on Hyperphosphatemia Among Patients With End-stage Renal DiseaseA Randomized Controlled Trial. JAMA 2009; 301:629-635
      • Williams P, Stevens M, Fass G, Irons L, Bone J. Failure of dietary protein and phosphate restriction to retard the rate of progression of chronic renal failure: a prospective, randomized, controlled trial. The Quarterly Journal of Medicine 1991; 81:837-55
  • Search Plan and Results: CKD: Electrolytes: Phosphorus (2018)
     
  What is the effect of dietary phosphorus/phosphate restriction on dietary phosphorus/phosphate intake in adults with CKD 1-5D and post-transplant?

  • Conclusion

    In CKD pre-dialysis patients, dietary phosphorus/phosphate restriction appeared to reduce dietary phosphorus/phosphate intakes in one study and a similar trend is noted among hemodialysis patients in another study.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the effect of dietary phosphorus/phosphate restriction on dietary phosphorus/phosphate intake in adults with CKD 1-5D and post-transplant?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Lou L, Caverni A, Gimeno J, Moreno R, Pérez J, Alvarez R, Campos B, García M, Gutiérrez A, Bielsa S, Castilla J, Sanz A, Martin F. Dietary intervention focused on phosphate intake in hemodialysis patients with hyperphosphoremia. Clinical Nephrology 2012; 77:476-83
      • Williams P, Stevens M, Fass G, Irons L, Bone J. Failure of dietary protein and phosphate restriction to retard the rate of progression of chronic renal failure: a prospective, randomized, controlled trial. The Quarterly Journal of Medicine 1991; 81:837-55
  • Search Plan and Results: CKD: Electrolytes: Phosphorus (2018)