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Abstract: FR-PO918

Intensity of Serum Phosphate Lowering Is Related to the Risk of RRT in Non-Dialysis Dependent (NDD)-CKD Patients with Hyperphosphatemia 

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Nie, Sheng, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
  • Gao, Qi, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
  • Zhou, Shiyu, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
  • Hao, Lichen, Sanofi, Bridgewater, New Jersey, United States
  • Zhang, Yan, Sanofi, Beijing, China
  • Yuan, Muhan, Sanofi, Beijing, China

Few studies have explored the association between intensity of serum phosphate lowering and risk of renal replacement therapy (RRT) in patients with non-dialysis dependent chronic kidney disease (NDD-CKD).


Data was extracted from the Optum Humedica EHR database. The study period started from July 1, 2007, to June 30, 2021. We enrolled NDD-CKD adult patients with two consecutive results of elevated serum phosphorus (defined as non-same day but ≤180 days apart, >4.5 mg/dL on both occasions). The study exposure was defined as the change in serum phosphorus concentration at 360 days after the enrollment. 360 days after the enrollment was defined as the index date. Study outcome was the initiation of RRT.


A total of 28,165 patients were analyzed, of whom 45% were male, the mean age was 60 years, and 43% were in CKD stage 5. Based on the changes in serum phosphorus concentration at 360 days, 11,599 (41.2%), 10,135 (36.0%), 3,165 (11.2%), 2,293 (8.1%) and 975 (3.5%) were categorized into the high decrease group (decrease of ≥25%), decrease group (decrease of 5% to 25%), stable group (decrease of <5% to increase of <5%), increase group (increase of 5% to <25%), and high increase group (increase ≥25%), respectively. The high decrease group and decrease group were associated with lower risk of RRT compared with the stable (high decrease: adjusted hazard ratio (aHR)=0.51, 95% confidence interval (CI): 0.47-0.56; decrease: aHR=0.75, 95% CI: 0.69-0.81). Meanwhile, the high increase group and increase group were associated with higher risk of RRT compared with the stable (high increase: aHR=1.34, 95% CI: 1.19-1.51; increase: aHR=1.24, 95% CI: 1.13-1.36).


The level of serum phosphate change was associated with the risk of RRT in patients with NDD-CKD and hyperphosphatemia. Our findings suggest that intensive lowering of serum phosphate might help to delay the time to RRT in patients with NDD-CKD.

The Kaplan-Meier curves of RRT-free probability in different groups.


  • Commercial Support – Sanofi