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

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, SeungHyeok Han, TaeHyun Yoo, Shin-Wook Kang

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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 6 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 6 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. Am J Clin Nutr 2017;106:311-21.

Original languageEnglish
Pages (from-to)311-321
Number of pages11
JournalAmerican Journal of Clinical Nutrition
Volume106
Issue number1
DOIs
Publication statusPublished - 2017 Jul 1

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Dietary Phosphorus
Chronic Renal Insufficiency
Diabetes Mellitus
Cohort Studies
Prospective Studies
Glomerular Filtration Rate
Kidney
Proteinuria
Causality
Phosphorus
Disease Progression
Epidemiology
Cardiovascular Diseases
Randomized Controlled Trials
Age Groups
Genome

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Yoon, Chang Yun ; Park, Jung Tak ; Jhee, Jong Hyun ; Noh, Juhwan ; Kee, Youn Kyung ; Seo, Changhwan ; Lee, Misol ; Cha, Min Uk ; Kim, Hyoungnae ; Park, Seohyun ; Yun, Hae Ryong ; Jung, Su Young ; Han, SeungHyeok ; Yoo, TaeHyun ; Kang, Shin-Wook. / High dietary phosphorus density is a risk factor for incident chronic kidney disease development in diabetic subjects : A community-based prospective cohort study. In: American Journal of Clinical Nutrition. 2017 ; Vol. 106, No. 1. pp. 311-321.
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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 6 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 6 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. Am J Clin Nutr 2017;106:311-21.",
author = "Yoon, {Chang Yun} and Park, {Jung Tak} and Jhee, {Jong Hyun} and Juhwan Noh and Kee, {Youn Kyung} and Changhwan Seo and Misol Lee and Cha, {Min Uk} and Hyoungnae Kim and Seohyun Park and Yun, {Hae Ryong} and Jung, {Su Young} and SeungHyeok Han and TaeHyun Yoo and Shin-Wook Kang",
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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. / Yoon, Chang Yun; Park, Jung Tak; Jhee, Jong Hyun; Noh, Juhwan; Kee, Youn Kyung; Seo, Changhwan; Lee, Misol; Cha, Min Uk; Kim, Hyoungnae; Park, Seohyun; Yun, Hae Ryong; Jung, Su Young; Han, SeungHyeok; Yoo, TaeHyun; Kang, Shin-Wook.

In: American Journal of Clinical Nutrition, Vol. 106, No. 1, 01.07.2017, p. 311-321.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High dietary phosphorus density is a risk factor for incident chronic kidney disease development in diabetic subjects

T2 - A community-based prospective cohort study

AU - Yoon, Chang Yun

AU - Park, Jung Tak

AU - Jhee, Jong Hyun

AU - Noh, Juhwan

AU - Kee, Youn Kyung

AU - Seo, Changhwan

AU - Lee, Misol

AU - Cha, Min Uk

AU - Kim, Hyoungnae

AU - Park, Seohyun

AU - Yun, Hae Ryong

AU - Jung, Su Young

AU - Han, SeungHyeok

AU - Yoo, TaeHyun

AU - Kang, Shin-Wook

PY - 2017/7/1

Y1 - 2017/7/1

N2 - 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 6 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 6 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. Am J Clin Nutr 2017;106:311-21.

AB - 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 6 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 6 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. Am J Clin Nutr 2017;106:311-21.

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