Hyperphosphatemia-Related Mortality Is Modified by Serum Albumin and Creatinine Levels in Hemodialysis Patients: The Q-Cohort Study.

作者：Shunsuke Yamada, H. Arase, M. Tokumoto, M. Taniguchi, K. Tsuruya, Toshiaki Nakano, T. Ago · 发表于：Journal of renal nutrition · 年份：2026 · DOI：10.1053/j.jrn.2026.04.012 · 研究领域：Medicine

OBJECTIVE Hyperphosphatemia is a well-established predictor of mortality in hemodialysis patients. However, its impact may vary depending on clinical conditions. We examined whether serum albumin and creatinine levels modify the association between hyperphosphatemia and mortality. DESIGN AND METHODS We conducted a prospective, multicenter cohort study involving 3,050 patients on maintenance hemodialysis, followed for up to four years. The primary outcomes were all-cause and cardiovascular mortality. Serum phosphorus levels were the main exposure, serum albumin and creatinine levels were evaluated as potential effect modifiers. Sensitivity analyses were performed using the Geriatric Nutritional Risk Index (GNRI) and modified creatinine index (mCI). Cox proportional hazards models were used to assess mortality risk. RESULTS Over a median follow-up of 3.5 years, 639 patients died, including 227 from cardiovascular causes. In multivariable-adjusted models, hyperphosphatemia was significantly associated with higher risks of both all-cause and cardiovascular mortality. Stratified analyses revealed that this association was significant only in patients with higher serum albumin or lower creatinine levels. Among patients with lower albumin or higher creatinine, the association was not significant. Significant interaction effects were observed between serum phosphorus and both albumin and creatinine, highlighting a potential modifying role of nutritional and muscular status in pho...