Serum Phosphorus Level May Be a Biomarker For Anemia Interview with:
Lac Tran, MD
Division of Nephrology and Hypertension
Kaiser Permanente Los Angeles Medical Center
Los Angeles, CA

Medical Research: What is the background for this study? What are the main findings?

Dr. Tran: Abnormal serum phosphorus levels have been associated with adverse cardiovascular outcomes and progression to renal failure.  Given phosphorus’s important biological roles in cellular replication and bone mineral metabolism, we sought to investigate the association between phosphorus levels and anemia in normal kidney function and early chronic kidney disease.

Our study is a population-based study among a large racially/ethnically diverse population within the Kaiser Permanente Southern California health system.
Among 155, 974 individuals, 4.1% had moderate anemia and 12.9% had mild anemia.  We found that phosphorus levels greater than 3.5 mg/dL and less than 2.0 mg/dL showed a greater likelihood for moderate anemia.  Every 0.5 mg/dL phosphorus level increase demonstrated a 16% greater likelihood for moderate anemia.  The highest phosphorus tertile of our population had a 26% greater likelihood for anemia compared to the middle tertile.  We also found that female sex, Asian race, diabetes, low albumin, and low iron saturation were risk factors for anemia.

Medical Research: What should clinicians and patients take away from your report?

Dr. Tran: Phosphorus may be a biomarker for anemia and play a role in hematopoiesis.  Theoretically, lowering the phosphorus level in individuals with serum phosphorus > 4.0 mg/dL may prevent anemia in our population with normal kidney function and early CKD.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Tran: Our study is a cross-sectional analysis, and therefore, a causal association cannot be made between phosphorus and anemia.   Future research should elucidate the mechanism of phosphorus in hematopoiesis, and the roles that parathyroid hormone, vitamin D, fibroblast-growth factor-23, and klotho may play.  Information on nutritional supplements and dietary phosphorus intake would be helpful in evaluating their effects on serum phosphorus levels.


Serum phosphorus and association with anemia among a large diverse population with and without chronic kidney disease.

Tran L, Batech M, Rhee CM, Streja E, Kalantar-Zadeh K, Jacobsen SJ, Sim JJ.

Nephrol Dial Transplant. 2015 Aug 8. pii: gfv297. [Epub ahead of print]

PMID: 26254460

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Lac Tran, MD (2015). Serum Phosphorus Level May Be a Biomarker For Anemia