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High dietary phosphorus density is a risk factor for incident chronic kidney disease development in diabetic subjects: a community-based prospective cohort study

Authors
 Chang-Yun Yoon  ;  Jung Tak Park  ;  Jong Hyun Jhee  ;  Juhwan Noh  ;  Youn Kyung Kee  ;  Changhwan Seo  ;  Misol Lee  ;  Min-Uk Cha  ;  Hyoungnae Kim  ;  Seohyun Park  ;  Hae-Ryong Yun  ;  Su-Young Jung  ;  Seung Hyeok Han  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang 
Citation
 AMERICAN JOURNAL OF CLINICAL NUTRITION, Vol.106(1) : 311-321, 2017 
Journal Title
 AMERICAN JOURNAL OF CLINICAL NUTRITION 
ISSN
 0002-9165 
Issue Date
2017
MeSH
Diabetes Mellitus*/pathology ; Diabetic Nephropathies/etiology* ; Diet ; Disease Progression ; Energy Intake* ; Feeding Behavior ; Female ; Glomerular Filtration Rate ; Humans ; Incidence ; Kidney/drug effects* ; Male ; Middle Aged ; Phosphorus/administration & dosage ; Phosphorus/adverse effects* ; Phosphorus, Dietary/administration & dosage ; Phosphorus, Dietary/adverse effects* ; Proportional Hazards Models ; Prospective Studies ; Proteinuria/etiology ; Reference Values ; Renal Insufficiency, Chronic/etiology* ; Risk Factors
Keywords
chronic kidney disease ; diabetes mellitus ; dietary phosphorus ; renal nutrition ; risk factor
Abstract
Background: High serum phosphorus concentrations are associated with an increased risk of cardiovascular disease and progression of chronic kidney disease (CKD). However, the relation between dietary phosphorus intake and CKD development has not been well evaluated.Objective: In this study, we investigated the impact of dietary phosphorus density on the development of incident CKD in a cohort of subjects with normal renal function.Design: Data were retrieved from the Korean Genome and Epidemiology Study, a prospective community-based cohort study. The study cohort consisted of subjects aged 40-69 y, who were followed up biennially from 2001 to 2014. A total of 873 subjects with diabetes mellitus (DM) and 5846 subjects without DM (non-DM) were included in the final analysis. The primary endpoint was incident CKD, defined as a composite of estimated glomerular filtration rate <60 mL · min-1 · 1.73 m-2 and/or the development of proteinuria.Results: In the DM and non-DM groups, the mean ages of the participants were 55.6 ± 8.7 and 51.4 ± 8.6 y, the numbers of male subjects were 454 (52.0%) and 2784 (47.6%), and the mean estimated glomerular filtration rates were 91.6 ± 14.0 and 94.5 ± 14.0 mL · min-1 · 1.73 m-2, respectively. The mean values of dietary phosphorus density, defined as the ratio of a single-day dietary phosphorus amount to the total daily calorie intake, were 0.51 ± 0.08 mg/kcal in the DM group and 0.51 ± 0.07 mg/kcal in the non-DM group. During the follow-up, CKD newly developed in 283 (32.4%) and 792 subjects (13.5%) in the DM and non-DM groups, respectively. When the subjects were divided into quartiles according to the dietary phosphorus density in each group, the highest quartile was significantly associated with the development of incident CKD by multiple Cox proportional hazard analysis in the DM group (P = 0.02) but not in the non-DM group (P = 0.72).Conclusions: High dietary phosphorus density is associated with an increased risk of CKD development in DM patients with normal renal function. The causality in this association needs to be tested in a randomized controlled trial.
Full Text
https://academic.oup.com/ajcn/article/106/1/311/4569816
DOI
10.3945/ajcn.116.151654
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kee, Youn Kyung(기연경)
Kim, Hyoung Rae(김형래)
Noh, Juhwan(노주환) ORCID logo https://orcid.org/0000-0003-0657-0082
Park, Seo Hyun(박서현)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Seo, Changhwan(서창환)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Lee, Mi Sol(이미솔)
Jung, Su Young(정수영)
Jhee, Jong Hyun(지종현)
Cha, Min Uk(차민욱)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160313
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