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Abstract: FR-PO814

Mortality Prediction in Hemodialysis Patients According to Dietary Protein Intake to Serum Phosphorus Ratio

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD


  • Bielopolski, Dana, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, United States
  • Obi, Yoshitsugu, University of California Irvine, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Lowering serum phosphorus (P) in maintenance hemodialysis (MHD) patients may improve survival. However, prior studies have shown that restricting dietary protein intake (estimated by “normalized protein catabolic rate”, nPCR), a major source of phosphorus, is associated with higher mortality.
We hypothesized that combing these two risks, nPCR and P, in the form of a new score can improve survival prediction.


Dividing the variables by one another enabled them to influence the metric equally. We divided phosphorus by 5.8, to create nP, so that distribution ranges of the two variables better overlap. Then new metric R, was formulated: R=nPCR/nP Analysis was carried in 63,016 MHD pts, who were followed for 5 years (2007-11). Survival models were adjusted for case-mix and malnutrition-inflammation cachexia syndrome (MICS).


Patients were divided to 5 groups according to R value. Group 1 had high phosphorus and low nPCR, the opposite of patients in group 5.
After 1 year follow-up survival difference between groups was according to numerical order. Association of R with mortality was strengthened with adjustment for case-mix variables. Adjusting HR to albumin improved prediction of patients with good prognosis.


The novel protein to phosphorus ratio score can predict mortality in MHD patients and may allow a better phosphorus monitoring while adequate protein intake is ensured.

Survival estimates according to fivR5 after 1 year 63,016 CEFDIM patients


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