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Abstract: SA-PO791

Variability of Serum Phosphate and Markers of Malnutrition and Inflammation in Hemodialysis Patients

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Ye, Xiaoling, Renal Research Institute , New York, United States
  • Kooman, Jeroen, Maastricht University Medical Centre, Maastricht, Netherlands
  • Raimann, Jochen G., Renal Research Institute , New York, New York, United States
  • Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Kotanko, Peter, Renal Research Institute , New York, New York, United States
Background

Several biomarkers show significant short- and long-term variability. Here we assessed the variabilities of phosphate(P), albumin(alb), creatinine (creat), nPCR, and neutrophil-to-lymphocyte ratio(NLR) and their associations with outcome.

Methods

All incident in-center HD pts treated in Fresenius Medical Care North America clinics from 10/2010 to 10/2018 were enrolled. The 6-months (mo) baseline (mo 4 to 9) preceded a 12-mos follow-up (mos 10 to 21). Biomarker baseline variability was described by several metrics:(i) standard deviation (SD); (ii) average real variability (ARV = 1/(N-1) * ∑ (i=1 ~ N-1) | X i+1 - Xi|; N is number of valid lab measurements); (iii) the directional range (DR), it is positive when the minimum antedates the maximum, otherwise negative. Cox proportional hazards models with spline terms were employed to investigate the association between these variables, their variability indicators, and all-cause mortality. ANOVA Cox proportional hazard models (adjusted for age, gender, race, diabetic, congestive heart failure) were built to study the interactions of these variables and their variability with outcome during follow-up.

Results

We enrolled 159703 patients,17037 died during follow-up. Baseline P was 5.1 mg/dL, median serum P SD, ARV, and DR were 0.91, 0.95, -0.91 mg/dL, respectively.The relation between P variability and all-cause mortality was consistent across a wide range of P levels. For alb, nPCR and creat the highest mortality was observed in patients with low P levels and negative DR.

Conclusion

The direct relation between P variability and mortality is present across levels of nutrition and inflammation. A high P variability should prompt the search for underlying causes, such as poor nutrition and inflammation, and potential interventions.