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Background <p>Existing research on phosphorus-lowering in CKD predominantly focuses on dialysis patients and intermediate biomarkers like serum phosphorus and PTH, lacking evidence on hard clinical outcomes such as ESRD progression or mortality in non-dialysis CKD. With limited supporting evidence in KDIGO guidelines, this study systematically evaluates active phosphate-lowering on mortality and renal progression in this population.</p> Methods <p>This study identified and included eligible RCTs from Chinese and English databases up to August 2025, including CNKI, Wanfang, VIP, CBM, Cochrane, Embase, Medline, and PubMed. Methodologically, it innovatively categorized subjects into "greater reduction" and "smaller reduction" groups based on actual achieved serum phosphate reduction, rather than by intervention type, to directly evaluate the relationship between phosphorus-lowering efficacy and clinical outcomes (mortality and dialysis).</p> Results <p>A total of 27 randomized controlled trials were included, involving 3149 non-dialysis CKD patients. Meta-analysis shows that actively reducing serum phosphorus can significantly delay the progression of renal function in non-dialysis CKD patients, reduce their all-cause mortality rate (RR, 0.52; 95% CI 0.35–0.75; heterogeneity <i>I</i><sup>2</sup> = 0%), and lower the risk of entering dialysis (RR, 0.60; 95% CI 0.48–0.75; heterogeneity <i>I</i><sup>2</sup> = 0%).</p> Conclusion <p>The results of the meta-analysis suggest that for non-dialysis CKD patients, actively intensifying phosphate-lowering therapy can effectively delay disease progression, delay dialysis initiation, and reduce the risk of death. The research results provide important basis for individualized phosphorus management strategies for non-dialysis CKD patients, and provide strong data support for the recommendations of controlling serum phosphorus in the KDIGO guidelines.</p>

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Meta-analysis of the impact of serum phosphorus reduction on the prognosis of non-dialysis CKD patients: evidence based on clinical outcomes

  • 期刊论文

  • 发表日期：

    2026年5月9日

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  • Yizhe Xin,
  • Rujia Wang,
  • Ying Guo,
  • Yue Qiu,
  • Bin Fu

摘要

Background

Existing research on phosphorus-lowering in CKD predominantly focuses on dialysis patients and intermediate biomarkers like serum phosphorus and PTH, lacking evidence on hard clinical outcomes such as ESRD progression or mortality in non-dialysis CKD. With limited supporting evidence in KDIGO guidelines, this study systematically evaluates active phosphate-lowering on mortality and renal progression in this population.

Methods

This study identified and included eligible RCTs from Chinese and English databases up to August 2025, including CNKI, Wanfang, VIP, CBM, Cochrane, Embase, Medline, and PubMed. Methodologically, it innovatively categorized subjects into "greater reduction" and "smaller reduction" groups based on actual achieved serum phosphate reduction, rather than by intervention type, to directly evaluate the relationship between phosphorus-lowering efficacy and clinical outcomes (mortality and dialysis).

Results

A total of 27 randomized controlled trials were included, involving 3149 non-dialysis CKD patients. Meta-analysis shows that actively reducing serum phosphorus can significantly delay the progression of renal function in non-dialysis CKD patients, reduce their all-cause mortality rate (RR, 0.52; 95% CI 0.35–0.75; heterogeneity I2 = 0%), and lower the risk of entering dialysis (RR, 0.60; 95% CI 0.48–0.75; heterogeneity I2 = 0%).

Conclusion

The results of the meta-analysis suggest that for non-dialysis CKD patients, actively intensifying phosphate-lowering therapy can effectively delay disease progression, delay dialysis initiation, and reduce the risk of death. The research results provide important basis for individualized phosphorus management strategies for non-dialysis CKD patients, and provide strong data support for the recommendations of controlling serum phosphorus in the KDIGO guidelines.