Serum phosphorus, cardiovascular and all-cause mortality in the general population: A meta-analysis

Bai, Wenwei; Li, Jing; Liu, Juan

doi:10.1016/j.cca.2016.07.020

Cited by 35 publications

(19 citation statements)

References 32 publications

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“…More interestingly, the relationship between high-normal serum phosphate and adverse outcomes extends beyond CKD population. Among population with preserved renal function (normally defined as eGFR >= 60 mL/min/1.73 m 2 ), the increase in serum phosphate not only displays a relationship with makers of atherosclerosis, for example, vascular and valvular calcifications, but also predicts atherosclerotic and nonatherosclerotic cardiovascular events and mortality [ 9 – 19 ]. The reported thresholds of serum phosphate for adverse outcomes were lower than CKD population and ranged between 2.5 and 3.8 mg/dL ( Table 1 ).…”

Section: Serum Phosphate and Outcomesmentioning

confidence: 99%

Phosphate and Cardiovascular Disease beyond Chronic Kidney Disease and Vascular Calcification

Disthabanchong

2018

International Journal of Nephrology

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Phosphate is essential for life but its accumulation can be detrimental. In end-stage renal disease, widespread vascular calcification occurs as a result of chronic phosphate load. The accumulation of phosphate is likely to occur long before the rise in serum phosphate above the normal range since several observational studies in both general population and early-stage CKD patients have identified the relationship between high-normal serum phosphate and adverse cardiovascular outcomes. Consumption of food high in phosphate increases both fasting and postprandial serum phosphate and habitual intake of high phosphate diet is associated with aging, cardiac hypertrophy, endothelial dysfunction, and subclinical atherosclerosis. The decline in renal function and dietary phosphate load can increase circulating fibroblast growth factor-23 (FGF-23) which may have a direct impact on cardiomyocytes. Increased FGF-23 levels in both CKD and general populations are associated with left ventricular hypertrophy, congestive heart failure, atrial fibrillation, and mortality. Increased extracellular phosphate directly affects endothelial cells causing cell apoptosis and vascular smooth muscle cells (VSMCs) causing transformation to osteogenic phenotype. Excess of calcium and phosphate in the circulation can promote the formation of protein-mineral complex called calciprotein particles (CPPs). In CKD, these CPPs contain less calcification inhibitors, induce inflammation, and promote VSMC calcification.

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Section: Serum Phosphate and Outcomesmentioning

confidence: 99%

Phosphate and Cardiovascular Disease beyond Chronic Kidney Disease and Vascular Calcification

Disthabanchong

2018

International Journal of Nephrology

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“…Inorganic phosphate is the value of serum phosphate measured in the clinic [1][2][3][4][5]. Although serum phosphate is very low, it plays an important role in the body [1][2][3][6][7][8][9]. For example, (I) participating in the composition of cell membranes in the form of phospholipids to maintain the integrity and function of the cell structure;…”

Section: Introductionmentioning

confidence: 99%

“…In the past few decades, there were some researches about the associations between abnormal serum phosphate levels and clinical outcomes. For hyperphosphatemia, most studies had proved that hyperphosphatemia was an independent risk factor for mortality or morbidity [1,7,11,14,15,[20][21][22][23][24][25][26]. For hypophosphatemia, some studies showed that it was an independent risk factor for mortality or morbidity [1,8,23,27], but some studies showed that it was not signi cantly associated with mortality or morbidity [15,20,22,28].…”

Section: Introductionmentioning

confidence: 99%

Is Monitoring for Phosphate a Necessary Measure in Critical Ill Patients ?

Chen

Luo

et al. 2020

Preprint

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Background: In recent years, some studies have shown that hyperphosphatemia and hypophosphatemia are associated with high mortality in intensive care unit (ICU) patients. Based on this, we speculated that the abnormalities of serum phosphate when patients enter the ICU had an adverse effect on the mortality of ICU patients and conducted our study.Methods: For our retrospective cohort study, we collected the data from a publicly accessible critical care database. We selected adult patients admitted to ICU with some inclusion criteria. And we extracted a large number of clinical variables. Using multivariate Cox regression and other statistical methods, we assessed the association between serum phosphate and primary endpoints.Results: Of 27131 eligible patients, the patients with hyperphosphatemia or hypophosphatemia had poorer clinical outcomes. After adjustment for potential confounders, there was no significant association between abnormalities phosphate and 28 or 90-day ICU mortality. Nevertheless, at the medical intensive care unit, hyperphosphatemia was associated with a 37% higher risk of 28-day mortality or a 25% higher risk of 90-day mortality.Conclusion: After adjustment for potential confounders, hypophosphatemia and hyperphosphatemia at ICU admission were not the independent risk factors of 28 or 90-day mortality for general ICU patients. However, hyperphosphatemia at admission increased the risk of 28 or 90-day mortality among patients admitted to the medical intensive care unit.

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“…High phosphate concentrations are linked with a higher prevalence of cardiovascular disease, both in patients with CKD [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ] and in healthy individuals [ 2 , 13 , 14 , 25 ]. Similarly, high phosphate concentrations have been linked to increased mortality among CKD patients [ 26 , 27 , 28 ] and among the general population [ 29 , 30 ]. A long-term high phosphate diet affects the bone structure [ 6 , 31 ] and the regulation of FGF23 and Klotho [ 17 , 28 , 32 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

Contribution of Drinking Water Softeners to Daily Phosphate Intake in Slovenia

Jereb

Poljšak

Eržen

2017

IJERPH

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The cumulative phosphate intake in a typical daily diet is high and, according to several studies, already exceeds recommended values. The exposure of the general population to phosphorus via drinking water is generally not known. One of the hidden sources of phosphorus in a daily diet is sodium polyphosphate, commonly used as a drinking water softener. In Slovenia, softening of drinking water is carried out exclusively within the internal (household) drinking water supply systems to prevent the accumulation of limescale. The aim of the study was to determine the prevalence of sodium phosphates in the drinking water in Slovenia in different types of buildings, to determine residents’ awareness of the presence of chemical softeners in their drinking water, and to provide an exposure assessment on the phosphorus intake from drinking water. In the current study, the presence of phosphates in the samples of drinking water was determined using a spectrophotometric method with ammonium molybdate. In nearly half of the samples, the presence of phosphates as water softeners was confirmed. The measured concentrations varied substantially from 0.2 mg PO4/L to 24.6 mg PO4/L. Nearly 70% of the respondents were not familiar with the exact data on water softening in their buildings. It follows that concentrations of added phosphates should be controlled and the consumers should be informed of the added chemicals in their drinking water. The health risks of using sodium polyphosphate as a drinking water softener have not been sufficiently investigated and assessed. It is highly recommended that proper guidelines and regulations are developed and introduced to protect human health from adverse effects of chemicals in water intended for human consumption.

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Serum phosphorus, cardiovascular and all-cause mortality in the general population: A meta-analysis

Cited by 35 publications

References 32 publications

Phosphate and Cardiovascular Disease beyond Chronic Kidney Disease and Vascular Calcification

Phosphate and Cardiovascular Disease beyond Chronic Kidney Disease and Vascular Calcification

Is Monitoring for Phosphate a Necessary Measure in Critical Ill Patients ?

Contribution of Drinking Water Softeners to Daily Phosphate Intake in Slovenia

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Serum phosphorus, cardiovascular and all-cause mortality in the general population: A meta-analysis

Cited by 35 publications

References 32 publications

Phosphate and Cardiovascular Disease beyond Chronic Kidney Disease and Vascular Calcification

Phosphate and Cardiovascular Disease beyond Chronic Kidney Disease and Vascular Calcification

Is&nbsp;Monitoring for Phosphate&nbsp;a Necessary Measure in Critical Ill Patients ?

Contribution of Drinking Water Softeners to Daily Phosphate Intake in Slovenia

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Is Monitoring for Phosphate a Necessary Measure in Critical Ill Patients ?