Associations of dietary phosphorus-protein ratio, phosphorus-energy ratio, and protein-energy ratio with mortality in peritoneal dialysis patients: a retrospective cohort study.

Authors

Zi-Zhen Wang, Ke Xu, Su-Xuan Liu, Si-Yu Yang, Xin-Xin Chen, Chun-Yan Su, Wen Tang

Published in

Frontiers in nutrition. Volume 13. Pages 1798804. Epub Jun 09, 2026.

Abstract

Optimal nutritional management in patients undergoing peritoneal dialysis (PD) requires balancing phosphorus restriction with adequate protein and energy intake. Nutrient density-based indicators, including the phosphorus-protein ratio, phosphorus-energy ratio, and protein-energy ratio, may better capture dietary structure than absolute nutrient intake; however, their prognostic significance in PD patients remains unclear.
This retrospective cohort study included adult patients who initiated PD at a single center between January 2006 and June 2021 and were followed until June 2023. Dietary phosphorus, protein, and energy intake were assessed using 3-day dietary records collected six months after PD initiation. The phosphorus-protein ratio, phosphorus-energy ratio, and protein-energy ratio were calculated as exposure indicators. Restricted cubic spline models were used to explore potential nonlinear associations with all-cause and cardiovascular mortality. Associations with all-cause mortality were evaluated using Cox proportional hazards models, while cardiovascular mortality was analyzed using both Cox and Fine-Gray competing risk models. In addition, sensitivity analyses were performed using methods such as excluding early deaths and incorporating repeated measurement data.
A total of 794 PD patients were included, with a median follow-up of 47 months, during which 412 deaths occurred, including 158 cardiovascular deaths. In the fully adjusted model, the phosphorus-protein ratio showed a significant nonlinear association with all-cause mortality (p for nonlinearity = 0.027), while the nonlinear association with cardiovascular mortality was borderline significant (p = 0.081). Compared with the second quintile [14.41 (14.15-14.62)mg/g], higher quintiles were associated with higher cardiovascular mortality. These findings were consistent in competing risk analyses. In contrast, the phosphorus-energy ratio (mg/100 kcal, HR = 1.015, 95% CI 1.004-1.025, p = 0.006), and protein-energy ratio (%, HR = 1.050, 95% CI 1.011-1.091, p = 0.011) showed linear positive associations with all-cause mortality.
Among patients undergoing PD, baseline dietary nutrient density indicators exhibit distinct associations with mortality outcomes. These findings raise the possibility that dietary structure, beyond absolute intake of individual nutrients, might offer additional insights for risk stratification and nutritional management in PD patients.

PMID:
42344876
Bibliographic data and abstract were imported from PubMed on 25 Jun 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.