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Serum Phosphate and Retinal Microvascular Changes: The Multi-Ethnic Study of Atherosclerosis and the Beaver Dam Eye
Rupal Mehta1,2,3, Alexander Hodakowski2, Xuan Cai2
1a Division of Nephrology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA.
Insights
Higher serum phosphate levels are linked to prevalent retinopathy, especially in individuals with diabetes. This suggests phosphate may be a risk factor for microvascular complications in the eye.
Area of Science:
- Ophthalmology
- Nephrology
- Endocrinology
Background:
- Elevated serum phosphate is a known risk factor for cardiovascular disease.
- Its role in microvascular complications, particularly retinopathy, in the general population is less understood.
- Chronic kidney disease (CKD) management often involves phosphate control.
Purpose of the Study:
- To investigate the association between serum phosphate levels and retinopathy in community-based populations.
- To examine the relationship between serum phosphate and retinal vessel caliber.
- To determine if serum phosphate is a risk factor for microvascular disease.
Main Methods:
- Prospective study involving 3919 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) and 3544 from the Beaver Dam Eye Study (BDES).
- Serum phosphate levels were measured and associated with prevalent retinopathy and retinal vessel caliber.
- Analyses were adjusted for multiple variables and stratified by diabetes status.
Main Results:
- Higher serum phosphate was significantly associated with prevalent retinopathy in both MESA and BDES cohorts.
- This association was stronger in individuals with diabetes.
- No significant association was found between serum phosphate and retinal vessel caliber or changes in retinopathy severity.
Conclusions:
- In community-living individuals without significant CKD, elevated serum phosphate is associated with prevalent retinopathy, particularly in those with diabetes.
- Further longitudinal studies in diabetic patients are warranted to explore this link.
- Serum phosphate may represent a novel risk factor for diabetic retinopathy.
Purpose:
Higher levels of serum phosphate are strongly linked to increased risk of cardiovascular disease and therapies aimed to lower serum phosphate are employed in the management of patients with chronic kidney disease (CKD). Data are limited, however, on serum phosphate as a risk factor for microvascular disease in community-based populations. It is important to determine the impact of novel risk factors, such as phosphate, on the microvasculature.
Methods:
We conducted a prospective study of 3919 individuals in the Multi-Ethnic Study of Atherosclerosis (MESA) and 3544 individuals in the Beaver Dam Eye Study (BDES) to test the associations of serum phosphate with retinopathy and retinal vessel caliber, and change in retinopathy severity and change in retinal vessel caliber.
Results:
Mean (standard deviation) serum phosphate was 3.66 (0.52) mg/dl in the MESA and 3.77 (0.55) mg/dl in the BDES. In multivariable adjusted models, phosphate was significantly associated with prevalent retinopathy in the MESA (Odds Ratio [OR] per 1 mg/dl increase in phosphate, 1.22; Confidence Interval [CI] 1.02-1.47) and the BDES (OR 1.06; CI 1.01-1.11). In stratified analyses, these relationships were even stronger and only seen in individuals with diabetes in both the MESA (OR 1.81; CI 1.30-2.53) and the BDES (OR 1.16; CI 1.05-1.29). Phosphate was not associated with incident or change in retinopathy severity, nor any retinal caliber outcome.
Conclusions:
Among community-living individuals with low prevalence of CKD, higher serum phosphate was associated with prevalent retinopathy in individuals with diabetes. Further longitudinal assessments in patients with diabetes necessitate further investigation.