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Association of serum phosphorus variability with coronary artery calcification among hemodialysis patients
Mengjing Wang1, Haiming Li1, Li You1
1Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Insights
Serum phosphorus variability significantly predicts coronary artery calcification (CAC) in maintenance hemodialysis (MHD) patients. Stabilizing phosphorus levels may reduce CAC, morbidity, and mortality in MHD patients.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Coronary artery calcification (CAC) is a significant predictor of mortality in patients undergoing maintenance hemodialysis (MHD).
- The precise mechanisms driving CAC development in MHD patients remain incompletely understood.
- Variability in serum phosphorus levels is a potential, yet under-explored, contributor to CAC pathogenesis.
Purpose of the Study:
- To investigate the association between coronary artery calcification score (CACs) and serum phosphorus variability in MHD patients.
- To identify predictors of CAC in this high-risk population.
- To explore the potential role of phosphorus fluctuations in the development of vascular calcification.
Main Methods:
- Seventy-seven adult MHD patients were enrolled, with CACs measured via computed tomography using the Agatston method.
- Serum phosphorus levels were recorded every three months over a defined period.
- Phosphorus variability was quantified using standard deviation (SD) and coefficient of variation (CV) from historical data; multivariate logistic regression analyzed predictors of CAC.
Main Results:
- A high prevalence of CAC was observed, with 78% of patients exhibiting CACs > 0.
- Multivariate analysis revealed significant independent associations between higher CACs and older age, female gender, elevated serum fibroblast growth factor 23, and increased phosphorus variability (both SD and CV).
- These associations remained consistent across various historical data windows (6-11 follow-up values).
Conclusions:
- Serum phosphorus variability emerges as a significant, independent predictor of coronary artery calcification in MHD patients.
- Maintaining stable serum phosphorus levels may be a crucial therapeutic strategy to mitigate coronary calcification.
- Reducing phosphorus variability could potentially decrease cardiovascular morbidity and mortality in the MHD population.
Abstract:
Coronary artery calcification (CAC) is associated with increased mortality in patients on maintenance hemodialysis (MHD), but the pathogenesis of this condition is not well understood. We evaluated the relationship of CAC score (CACs) and variability in serum phosphorus in MHD patients. Seventy-seven adults on MHD at Huashan Hospital (Shanghai) were enrolled in July, 2010. CAC of all the patients were measured by computed tomography and CACs was calculated by the Agatston method at the entry of enrollment. Patients were divided into three categories according to their CACs (0∼10, 11∼400, and >400). Blood chemistry was recorded every 3 months from January 2008 to July 2010. Phosphorus variation was defined by the standard deviation (SD) or coefficient of variation (CV) and it was calculated from the past records. The ordinal multivariate logistic regression analysis was used to analyze the predictors of CAC. The mean patient age (± SD) was 61.7 years (±11.3) and 51% of patients were men. The mean CACs was 609.6 (±1062.9), the median CACs was 168.5, and 78% of patients had CACs more than 0. Multivariate analysis indicated that female gender (OR = 0.20, 95% CI = 0.07-0.55), age (OR = 2.31, 95% CI = 1.32-4.04), serum fibroblast growth factor 23 (OR = 2.25, 95% CI = 1.31-3.85), SD-phosphorus calculated from the most recent 6 measurements (OR = 2.12; 95% CI = 1.23-3.63), and CV-phosphorus calculated from the most recent 6 measurements (OR = 1.90, 95% CI = 1.16-3.11) were significantly and independently associated with CACs. These associations persisted for phosphorus variation calculated from past 7, 8, 9, 10, and 11 follow-up values. Variability of serum phosphorus may contribute significantly to CAC and keeping serum phosphorus stable may decrease coronary calcification and associated morbidity and mortality in MHD patients.
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