Association of pretransplant serum phosphorus with posttransplant outcomes

Marcelo S. Sampaio, Miklos Z. Molnar, Csaba P. Kovesdy, Rajnish Mehrotra, Istvan Mucsi, John J. Sim, Mahesh Krishnan, Allen R. Nissenson, Kamyar Kalantar-Zadeh

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Background and objectives Serum phosphorus levels are associated with mortality, cardiovascular disease, and renal function loss in individuals with and without chronic kidney disease. The association of pretransplant serum phosphorus levels with transplant outcomes is not clear. Design, setting, participants, & measurements Data of the Scientific Registry of Transplant Recipients (SRTR) up to June 2007 were linked to the database (2001 through 2006) of one of the U.S.-based large dialysis organizations (DaVita). The selected 9384 primary kidney recipients were divided into five groups according to pretransplant serum phosphorus levels (mg/dl): <3.5, 3.5 to <5.5 (reference group), 5.5 to <7.5, 7.5 to <9.5, and ≥ 9.5. Unadjusted and multivariate adjusted risks for transplant outcomes were compared. Results Patients were 48±14 years old and included 37% women and 27% African Americans. After multivariate adjustment, all-cause and cardiovascular death hazard ratios were 2.44 (95% confidence interval: 1.28 to 4.65) and 3.63 (1.13 to 11.64), respectively, in recipients in the ≥9.5 group; allograft loss hazard ratios were 1.42 (1.04 to 1.95) and 2.36 (1.33 to 4.17) in recipients with 7.5 to > 9.5 and ≥ 9.5, respectively. No significant association with delayed graft function was found. Conclusions Pretransplant phosphorus levels 7.5 to > 9.5 mg/dl and ≥ 9.5 mg/dl were associated with increased risk of functional graft failure and increased risk of all-cause and cardiovascular deaths, respectively, when compared with 3.5 to < 5.5 mg/dl. Additional studies are needed to examine whether more aggressive control of pretransplant serum phosphorus may improve posttransplant outcomes.

Original languageEnglish
Pages (from-to)2712-2721
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Issue number11
Publication statusPublished - Nov 1 2011


ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Sampaio, M. S., Molnar, M. Z., Kovesdy, C. P., Mehrotra, R., Mucsi, I., Sim, J. J., Krishnan, M., Nissenson, A. R., & Kalantar-Zadeh, K. (2011). Association of pretransplant serum phosphorus with posttransplant outcomes. Clinical Journal of the American Society of Nephrology, 6(11), 2712-2721.