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Age- and sex-tailored serum phosphate thresholds do not improve cardiovascular risk estimation in CKD
Pietro Manuel Ferraro1, Monica Bonello, Alessia Gambaro
1Division of Nephrology and Dialysis, Department of Internal Medicine and Medical Specialties, Renal Program, Columbus-Gemelli University Hospital, Catholic University of Rome, Rome, Italy. manuel.ferraro@tiscali.it
Insights
Tailored hyperphosphatemia cutoffs for cardiovascular risk in chronic kidney disease (CKD) patients were not superior to standard definitions. Age and sex did not improve prediction of cardiovascular events or mortality using these new hyperphosphatemia measures.
Area of Science:
- Nephrology
- Cardiology
- Metabolic Disorders
Background:
- Disordered phosphorus metabolism is a key feature of chronic kidney disease (CKD), contributing to cardiovascular morbidity and mortality.
- Serum phosphorus levels may be influenced by patient age and sex.
- Evaluating age- and sex-specific hyperphosphatemia cutoffs could refine cardiovascular risk assessment in CKD.
Purpose of the Study:
- To assess if age- and sex-specific hyperphosphatemia cutoffs better predict cardiovascular disease (CVD) and mortality in CKD patients compared to current guidelines.
- To investigate the relationship between tailored hyperphosphatemia definitions and cardiovascular outcomes.
Main Methods:
- Analysis of 1999-2006 National Health and Nutrition Examination Survey (NHANES) data from 16,834 subjects.
- Comparison of cardiovascular disease prevalence and mortality rates using classic (CH) versus tailored (TH) hyperphosphatemia definitions in CKD patients.
- Regression models adjusted for age, sex, race/ethnicity, smoking, and BMI; TH cutoffs based on the 95th percentile of non-CKD individuals.
Main Results:
- Serum phosphorus inversely correlated with age (r = -0.12; p<0.001) and was higher in females than males (p<0.001).
- The tailored hyperphosphatemia definition showed a marginally better association with CVD (OR=1.49) than the classic definition (OR=1.55), but this did not reach statistical significance for superiority.
- The tailored model did not demonstrate superior predictive capability for CVD or mortality compared to conventional definitions.
Conclusions:
- A tailored, age- and sex-specific definition of hyperphosphatemia does not offer superior prediction of cardiovascular events in CKD patients.
- Conventional definitions of hyperphosphatemia remain relevant for assessing cardiovascular risk in this population.
- Further research may be needed to identify optimal risk stratification strategies for cardiovascular complications in CKD.
Background:
Disordered metabolism of phosphorus is one of the hallmarks of chronic kidney disease (CKD), resulting in increased cardiovascular morbidity and mortality. Age and sex may affect the metabolism of phosphorus and subsequently its serum level. We evaluated if age- and sex-specific cutoffs for hyperphosphatemia may define cardiovascular risk better than the current guideline cutoffs.
Methods:
We used data from 16,834 subjects participating in the 1999-2006 National Health and Nutrition Examination Survey (NHANES); the prevalence of self-reported cardiovascular disease (CVD) and mortality rates were analyzed in CKD patients for both the classic definitions (CH; i.e., NKF-KDOQI and K-DIGO) and a tailored definition (TH) of hyperphosphatemia by means of regression models adjusted for age, sex, race/ethnicity, smoking status and body mass index. The cutoffs for TH were represented by the 95th percentile of an age- and sex-matched non-CKD population.
Results:
Serum phosphorus levels showed an inverse correlation with age (r = -0.12; p<0.001); females showed higher levels than males (3.78 ± 0.54 mg/dL vs. 3.62 ± 0.58 mg/dL; p<0.001). Even if the association between the TH definition and CVD was marginally better compared with the CH definition (odds ratio [OR] = 1.49, 95% confidence interval [95% CI], 1.04-2.13; p=0.030 vs. OR=1.55, 95% CI, 0.98-2.44; p = 0.059), the TH model was not superior in predicting CVD or mortality.
Conclusions:
Our data suggest that a tailored, age- and sex-specific definition of hyperphosphatemia is not superior to conventional definitions in predicting cardiovascular events in patients with CKD.
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