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Association of serum phosphate with vascular and valvular calcification in moderate CKD

Kathryn L Adeney1, David S Siscovick, Joachim H Ix

  • 1University of Washington, Department of Epidemiology, Harborview Medical Center, Seattle, WA 98104, USA.

Journal of the American Society of Nephrology : JASN
|December 17, 2008
PubMed

Insights

Higher serum phosphate levels, even within the normal range, are linked to increased vascular and valvular calcification in individuals with chronic kidney disease (CKD). This suggests phosphate may play a direct role in calcification risk for CKD patients.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Biochemistry

Background:

  • Elevated serum phosphate is a known risk factor for cardiovascular events and mortality in chronic kidney disease (CKD) and normal kidney function populations.
  • Experimental data indicates phosphate directly promotes vascular smooth muscle calcification.

Purpose of the Study:

  • To investigate the association between serum phosphate concentrations and vascular and valvular calcification in individuals with moderate CKD.
  • To determine if normal-range phosphate levels impact calcification prevalence in CKD patients.

Main Methods:

  • Analysis of 439 participants from the Multi-Ethnic Study of Atherosclerosis with moderate CKD and no prior cardiovascular disease.
  • Measurement of coronary artery, thoracic aorta, aortic valve, and mitral valve calcification using computed tomography.
  • Statistical adjustment for demographics, estimated glomerular filtration rate (eGFR), traditional atherosclerosis risk factors, parathyroid hormone, and 1,25-dihydroxyvitamin D levels.

Main Results:

  • 95% of participants had serum phosphate concentrations within the normal range (2.5–4.5 mg/dl).
  • Increased serum phosphate was significantly associated with higher prevalence of coronary artery (21%), thoracic aorta (33%), and mitral valve (62%) calcification.
  • These associations persisted after adjusting for multiple confounding factors, including eGFR and traditional cardiovascular risk factors.

Conclusions:

  • Higher serum phosphate concentrations, even within the normal range, are associated with increased vascular and valvular calcification in moderate CKD.
  • Phosphate may be an independent risk factor for calcification in CKD.
  • Further research is needed to determine if phosphate-lowering therapies can mitigate calcification risk in CKD.

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