Association of Calcium‐Phosphorus Product With Blood Pressure in Dialysis

Abstract

J Clin Hypertens (Greenwich). 2010;12:96–103. ©2009 Wiley Periodicals, Inc. Hypertension is very common in dialysis patients. Disorders of mineral metabolism have been linked to vascular calcification and hypertension in dialysis. Fifty‐four hemodialysis patients were included in a cross‐sectional study in a dialysis unit during a 6‐month period. Linear regression analysis was done between averages of calcium and phosphorus (ca × ph) product and blood pressures (BPs). Ca × ph was significantly associated with systolic BP predialysis (P=.03, R=0.28), diastolic BP predialysis (P=.001, R=0.44), predialysis mean arterial pressure (MAP) (P=.002, R=0.4), and diastolic BP postdialysis (P=.03, R=0.26). No relationship was found with pulse pressures. Multilinear regression analysis was then done between ca × ph product and BPs adjusting for age, sex, hemoglobin, diabetes, albumin, parathyroid hormone, ultrafiltration volume, and average BP medications per patient. There was a strong positive association with predialysis systolic BP (P=.003, R2=0.49), predialysis MAP (P=.001, R2=0.51), and postdialysis MAP (P=.02, R2=0.65). No associations with pulse pressures were detected. The study findings suggest that ca × ph product is significantly associated with dialysis MAP and not pulse pressure. This is likely secondary to the stronger relationship with diastolic BP than with systolic BP. Prospective studies looking into the associated hemodynamic parameters related to arterial stiffness and endothelial dysfunction along with measures for calcifications would be very beneficial.

Correlation between Calcium Phosphorus Product and Mean Arterial Pressure among Hemodialysis Patients with End Stage Renal Disease

“…Jean et al, also reported similar results in dialysis patients (10). Adragao et al, have publicized that higher vascular calcification scores in dialysis patients were associated with higher mean arterial pressure (11). The total serum calcium x phosphate product is an indicator of the risk of mineral crystallization in soft tissues, (17) which can lead to cutaneous and systemic calciphylaxis, conjunctival precipitation, visceral and in particular, cardiovascular calcification (18).…”

“…Jean et al concluded that vascular calcifications are highly prevalent in hemodialysis patients and not linked to blood pressure (10). However, Adragao et al conducted a prospective study and concluded that higher vascular calcification scores in dialysis patients were significantly associated with MAP and coronary artery disease (11). In another cross-sectional study conducted by Ashkar, it was cited that calcium phosphorous product (CPP) is positively associated with MAP and unrelated to pulse pressure (12).…”

Co-relation Between Calcium-Phosphorus Product and Hypertension in End-Stage Renal Disease Patients

“…Another study from the USA, which studied the relationship between serum phosphate levels and blood pressure in incident hemodialysis patients, found that elevated serum phosphate was associated with higher pre-dialysis SBP and PP with a 1.77 mmHg rise in SBP for each 1 mg/dL higher phosphorous level. Ashkar ZM, in his cross-sectional study, found a significant association between the Ca-P product and pre-dialysis SBP and MAP and both pre and post-dialysis DBP [ 21 ]. No relationship was detected with PP.…”

Improved Identification and Antihypertension Pharmacotherapy in Cardiorenal Metabolic Syndrome: Focus on Racial/Ethnic Minorities, Olmesartan Medoxomil, and Combination Therapy

“…The seated cuff (Se) BP goal of <130/80 mm Hg for patients with T2DM was achieved by 62% of the patients after 18 weeks of treatment [53]. Blacks and Hispanics comprised 17 and 26% of the study population, respectively [53], and 81% of the patients had MetS [54]. …”