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Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large
Andrew Peter McGovern1, Simon de Lusignan, Jeremy van Vlymen
1Department of Health Care Management and Policy, University of Surrey, Guildford, United Kingdom.
Insights
Serum phosphate levels impact cardiovascular risk in both general and chronic kidney disease (CKD) populations. Higher phosphate is linked to increased cardiovascular events, especially in advanced CKD stages.
Area of Science:
- Nephrology
- Cardiology
- Clinical Biochemistry
Background:
- Serum phosphate is a recognized risk factor for cardiovascular events and mortality in chronic kidney disease (CKD) patients.
- Data linking serum phosphate to cardiovascular outcomes in the general population are limited.
- This study investigates the association between serum phosphate and cardiovascular events in a large community-based cohort with and without CKD.
Purpose of the Study:
- To examine the relationship between serum phosphate levels and cardiovascular events in individuals with normal renal function and varying stages of CKD.
- To assess the impact of both hyperphosphatemia and hypophosphatemia on cardiovascular outcomes.
- To adjust for established cardiovascular risk factors in the analysis.
Main Methods:
- Utilized data from an adult cohort of the Quality Improvement in Chronic Kidney Disease (QICKD) trial.
- Followed three groups: normal renal function (N=24,184), CKD stages 1-2 (N=20,356), and CKD stages 3-5 (N=13,292) over 2.5 years.
- Employed multilevel logistic regression to analyze the association between serum phosphate and a composite outcome of mortality, cardiovascular events, and advanced coronary artery disease, controlling for known risk factors.
Main Results:
- Elevated serum phosphate correlated with increased cardiovascular risk across groups.
- In normal renal function and CKD stages 1-2, phosphate levels of 1.25-1.50 mmol/l were associated with higher cardiovascular events (OR 1.36 and 1.40, respectively).
- Hypophosphatemia (<0.75 mmol/l) showed a protective association in normal renal function (OR 0.59).
- In CKD stages 3-5, hyperphosphatemia (>1.50 mmol/l) significantly increased cardiovascular risk (OR 2.34).
Conclusions:
- Serum phosphate levels are significantly associated with cardiovascular events in both individuals with and without chronic kidney disease.
- The findings highlight the importance of monitoring serum phosphate in cardiovascular risk assessment.
- Further research is needed to elucidate the underlying mechanisms driving these associations.
Background:
Serum phosphate is a known risk factor for cardiovascular events and mortality in people with chronic kidney disease (CKD), however data on the association of these outcomes with serum phosphate in the general population are scarce. We investigate this relationship in people with and without CKD in a large community-based population.
Methods:
Three groups from an adult cohort of the Quality Improvement in Chronic Kidney Disease (QICKD) cluster randomised trial (ISRCTN56023731) were followed over a period of 2.5 years: people with normal renal function (N = 24,184), people with CKD stages 1-2 (N = 20,356), and people with CKD stages 3-5 (N = 13,292). We used a multilevel logistic regression model to determine the association between serum phosphate, in these groups, and a composite outcome of all-cause mortality, cardiovascular events, and advanced coronary artery disease. We adjusted for known cardiovascular risk factors.
Findings:
Higher phosphate levels were found to correlate with increased cardiovascular risk. In people with normal renal function and CKD stages 1-2, Phosphate levels between 1.25 and 1.50 mmol/l were associated with increased cardiovascular events; odds ratio (OR) 1.36 (95% CI 1.06-1.74; p = 0.016) in people with normal renal function and OR 1.40 (95% CI 1.09-1.81; p = 0.010) in people with CKD stages 1-2. Hypophosphatemia (<0.75 mmol/l) was associated with fewer cardiovascular events in people with normal renal function; OR 0.59 (95% CI 0.36-0.97; p = 0.049). In people with CKD stages 3-5, hyperphosphatemia (>1.50 mmol/l) was associated with increased cardiovascular risk; OR 2.34 (95% CI 1.64-3.32; p<0.001). Other phosphate ranges were not found to have a significant impact on cardiovascular events in people with CKD stages 3-5.
Conclusions:
Serum phosphate is associated with cardiovascular events in people with and without CKD. Further research is required to determine the mechanisms underlying these associations.
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