Serum Phosphorus and Kidney Disease Quality of Life (KDQoL) Among Maintenance Hemodialysis (HD) Patients

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Background: Dialysis patients experience lower health-related quality of life (QoL) compared to the general population. Previous studies have shown both high and low serum phosphorus (sP) concentrations were associated with lower physical component score of KDQoL among incident dialysis patients; however, the findings were not consistent. The aim of this study was to evaluate the associations between sP and KDQoL among HD patients on phosphate binders (PB). Methods: Eligible patients were adults receiving in-center HD from Fresenius Kidney Care (FKC) facilities who filled out KDQoL-SF 36 during the year of 2019 and had available information on sP within 30 days prior to/on KDQoL survey completion date. Stratified random sampling were applied on 17,757 patients to select the analysis cohort defined by sP levels (<3.5 mg/dL, 3.5 to 5.5 mg/dL, >5.5 to 6.5 mg/dL, >6.5 to 7.5 mg/dL, >7.5 to 8.5 mg/dL, and >8.5 mg/dL), with 100 patients matched on age for each sP category. ANOVA and linear regression were used to examine the associations between sP and KDQoL. Higher scores represented better QoL. Age, gender, race, ethnicity, diabetes, CHF, cinacalcet use, BMI, vintage, Charlson Comorbidity Index (CCI), albumin, hemoglobin, calcium, iPTH, PB pills per day, total pills, TSAT, and spKt/V were considered in the multivariable analysis. Results: Higher sP levels were associated with lower scores in KDQoL scales of symptoms/problems, burden of kidney disease, effects of kidney disease, and mental health (p<0.05; figure). After controlling for respective covariates, sP levels remained associated with symptoms/problems, burden of kidney disease, and effects of kidney disease. Conclusions: Among HD patients who were prescribed PB monotherapy, higher serum phosphorus was associated with lower scores of KDQoL scales of symptoms/problems, burden of kidney disease, and effects of kidney disease. Prospective studies may be warranted to determine whether or to what extent QoL may improve with measures to lower sP. Funding: Commercial Support - Fresenius Medical Care

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