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Updated: Jun 5, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Serum phosphate but not pulse wave velocity predicts decline in renal function in patients with early chronic kidney
Colin D Chue1, Nicola C Edwards, Laura J Davis
1Department of Cardiology, Queen Elizabeth Hospital, Birmingham and University of Birmingham, Birmingham, UK.
Insights
High serum phosphate levels predict faster kidney function decline in chronic kidney disease (CKD). Lowering phosphate may help preserve kidney function in early CKD patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Biochemistry
Background:
- Kidney function decline predicts cardiovascular risk in chronic kidney disease (CKD).
- Elevated serum phosphate and arterial stiffness are linked to cardiovascular risk in CKD and the general population.
- The predictive role of serum phosphate and arterial stiffness on renal dysfunction progression in early CKD requires investigation.
Purpose of the Study:
- To determine if serum phosphate and arterial stiffness markers predict renal dysfunction progression in early CKD patients.
- To assess the association between serum phosphate, arterial stiffness, and the rate of estimated glomerular filtration rate (eGFR) decline.
- To examine the combined endpoint of starting dialysis or a 25% decline in eGFR.
Main Methods:
- Prospective follow-up of 225 patients with Stage II-IV CKD.
- Baseline measurement of serum phosphate and arterial stiffness (aortic pulse wave velocity [PWV] and augmentation index [AIx]).
- Progression of renal dysfunction defined as the slope of eGFR over time; analysis of a combined endpoint.
Main Results:
- Serum phosphate independently predicted a steeper decline in eGFR (0.34 mL/min/month per 1 mmol/L increment, P=0.02).
- Brachial and aortic systolic pressure independently predicted renal function decline, but aortic PWV and AIx did not.
- Serum phosphate was higher in patients reaching the combined endpoint (dialysis or ≥25% eGFR decline) and independently predicted this outcome.
Conclusions:
- Serum phosphate is an independent predictor of renal function decline in early CKD.
- Further research is needed to elucidate the mechanisms and evaluate phosphate-lowering therapies for kidney function preservation.
Background:
The rate of decline in kidney function is a powerful predictor of cardiovascular risk in patients with chronic kidney disease (CKD). Serum phosphate and increased arterial stiffness are associated with elevated cardiovascular risk in CKD and the general population. We sought to determine whether serum phosphate and markers of arterial stiffness predict progression of renal dysfunction in patients with early CKD.
Methods:
Two hundred and twenty-five patients with Stage II-IV CKD were prospectively followed up at University Hospital Birmingham. Serum phosphate was measured at baseline and arterial stiffness was determined through measurement of aortic pulse wave velocity (PWV) and augmentation index (AIx). Progression of renal dysfunction was defined as the slope of estimated glomerular filtration rate (eGFR) against time. We determined the associations between possible predictors and rate of progression and also examined a combined end point of start of dialysis or ≥ 25% decline in eGFR.
Results:
Mean baseline eGFR was 43 ± 19 mL/min/1.73 m(2) and serum phosphate 1.22 ± 0.27 mmol/L. Median follow-up was 924 days. Serum phosphate independently predicted a greater decline in eGFR; a 1 mmol/L increment in serum phosphate was associated with a 0.34 mL/min/month steeper decline (P = 0.02). Brachial and aortic systolic pressure independently predicted the rate of renal function decline but aortic PWV and AIx had no significant influence. Forty-one patients (18%) reached the combined end point; serum phosphate was significantly higher in this group (1.32 ± 0.36 versus 1.19 ± 0.24 mmol/L, P = 0.04) and was an independent predictor for the combined end point.
Conclusions:
Serum phosphate independently predicts decline in renal function in early CKD. Further studies are required to determine the mechanisms involved and to investigate the potential benefits of phosphate lowering on preserving kidney function.
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