Original InvestigationPathogenesis and Treatment of Kidney DiseaseSerum Phosphorus and Progression of CKD and Mortality: A Meta-analysis of Cohort Studies
Section snippets
Search Strategy and Selection Criteria
We undertook a systematic review of the literature according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines.9 Relevant studies were identified by searching the following data sources: MEDLINE (Ovid; from January 1950 to June 2014), EMBASE (from January 1970 to June 2014), and the Cochrane Library database (Cochrane Central Register of Controlled Trials [CENTRAL]; no date restriction). We used Medical Subject Headings (MeSH) and text words of chronic
Characteristics and Quality of Studies
Our literature search returned 5,891 results for relevant articles. Of these, we reviewed the full text of 55 reports, from which we identified 12 cohort studies of adults with CKD in the meta-analysis (Fig 1). All cohort studies were published from 2005 to 2014 and involved a total of 25,546 patients with CKD.7, 8, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 Characteristics of included studies are provided in Table 1. Of those patients, 0.6% were in CKD stage 1; 2%, stage 2; 85%, stage 3; and
Discussion
Recent studies have indicated that phosphorus may play an independent pathogenic role in CKD progression,7 but some of those studies are underpowered and yield inconsistent results.8 To our knowledge, this is the first systematic review and meta-analysis of serum phosphorus level and outcomes in CKD and included 12 cohort studies with 25,546 patients with CKD. Our study indicates that higher serum phosphorus level is an independent risk factor for kidney disease progression and mortality among
Acknowledgements
We thank Rajnish Mehrotra and the KEEP Study group, Biagio R. Di Iorio, and Antonio Bellasi for providing useful additional information for this meta-analysis.
Support: Design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript were supported by the Research Special Fund for Public Welfare Industry of Health from National Health and Family Planning Commission of the People’s Republic of China (201002010
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