Association of serum calcium and phosphorus with measures of left ventricular structure and function: The ARIC study

Poudel, K.; Shah, Amil M.; Michos, Erin D.; Folsom, Aaron R.; Konety, Suma; Lutsey, Pamela L.

doi:10.1016/j.numecd.2020.01.003

Cited by 12 publications

(14 citation statements)

References 41 publications

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“…Possible explanations include low muscle strength, subclinical vascular disease, vascular calcification, cardiovascular disorders, etc. (12,17,(31)(32)(33)(34). Several studies have shown that an increase of serum phosphate within the normal range can independently predict a greater likelihood of vascular calcification or increased arterial stiffness in CKD and the general population (32).…”

Section: Discussionmentioning

confidence: 99%

“…The predictive value of serum Pi has been studied in several specific patient populations. It was reported that even a minor increase in serum Pi was associated with a higher risk of several adverse outcomes including worsened heart failure and all-cause mortality in patients with heart failure ( 10 – 12 ). Numerous studies have confirmed the association between higher serum Pi and adverse outcomes in patients with chronic kidney disease (CKD) with or without kidney transplantation ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Effect of Serum Phosphate on the Prognosis of Septic Patients: A Retrospective Study Based on MIMIC-IV Database

Shen

Han

2022

Front. Med.

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ObjectiveTo assess the effect of serum inorganic phosphate (Pi) on the prognosis of patients with sepsis.MethodsA retrospective analysis of patients with sepsis selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database was performed. Sepsis was diagnosed according to the Third International Consensus Definition for sepsis and septic shock (Sepsis-3). The time-weighted values of the serum Pi measurements within the first 24 h of sepsis were analyzed. The association between serum Pi and in-hospital mortality was evaluated with a generalized linear model (log-binomial model).ResultsThe analysis of 11,658 patients from six intensive care units (ICUs) showed a nearly linear correlation between serum Pi and in-hospital mortality in all patients with sepsis, especially in those with acute kidney injury (AKI). The increase of serum Pi was related to a higher risk of AKI, higher norepinephrine doses, ICU mortality, and in-hospital mortality. The generalized linear model showed that serum Pi was an independent predictor for in-hospital mortality in all patients with sepsis even within the normal range. The adjusted risk ratios (RRs) were also significant in subgroup analyses according to kidney function, gender, respiratory infection, vasopressor use, and Sequential Organ Failure Assessment (SOFA) score.ConclusionHigher levels of serum Pi, even within the normal range, were significantly associated with a higher risk of in-hospital mortality in patients with sepsis regardless of kidney function, gender, respiratory infection, vasopressor use, and SOFA score.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Serum Phosphate on the Prognosis of Septic Patients: A Retrospective Study Based on MIMIC-IV Database

Shen

Han

2022

Front. Med.

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“…The implications, however, of silent, sub-clinical deviations from normocalcemia are without definition and largely unknown. Though, there is evidence to suggest that variation in serum Ca 2+ ranges is indeed consequential and has implications for disease susceptibility [28][29][30][31][32][33][34].…”

Section: Implications For Clinical Theorymentioning

confidence: 99%

“…Present findings suggest there exists a U-shaped curve associated with serum Ca 2+ [28]; subjects in the highest tertiles of "normal" serum Ca 2+ (> 9.8 -9.9 mg/dL serum-corrected calcium (sCA)) face outsized risk across a range of cardiovascular, endocrine and neurologic diseases including but not limited to: atherosclerosis, left ventricular ejection fraction, cardiac remodeling, ischemic stroke risk, acute myocardial infarction (AMI), hypertension, dementia and insulin resistance [28][29][30][31][32]. Similarly, subjects with low sCA appear to face similar but not identical risks such as renal dysfunction, dementia, impaired stroke and acute myocardial infarction recovery [28,33,34].…”

Section: Implications For Clinical Theorymentioning

confidence: 99%

Calcium: More Than Bone? Implications for Clinical Practice and Theory

Hands

Moy

2021

J Clin Med Res

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Serum calcium is routinely screened, but rarely scrutinized in the context of normal, physiologic functioning. This brief review strives to explore the implications of serum calcium, suggests guidelines for its interpretation, and discusses the implications of high, low, and “normocalcemia” in the clinical setting. We find that serum Ca 2+ concentrations are a valuable prognostic indicator in routine metabolic workups and advocate for greater attention, on behalf of the provider, to variations in a patient’s calcemic status. Variations in calcemic status are primarily tied to malignancy, impaired parathyroid hormone (PTH) secretion, defects in vitamin D synthesis, insulin-like growth factor 1 (IGF-1) fluctuation, genetic syndromes (DiGeorge syndrome) and calcium-sensing receptor ( CaSR ) mutation. Prognostic implications for high and low serum Ca 2+ include, but are not limited to, increased thromboembolic and major adverse cardiovascular event (MACE) risk, cardiac remodeling, hypertension, cognitive decline, and insulin resistance.

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“…Ca is the central element of excitation-contraction coupling, so that hypercalcemia impairs the relaxation [16]. It has been described an association between serum Ca and ventricular end-diastolic diameter [17], and other parameters of myocardial relaxation [18].…”

Section: Introductionmentioning

confidence: 99%

The Impact of A Reduction of Dialysate Calcium on Diastolic Function in Patients on Peritoneal Dialysis: A Prospective Study

Piraciaba

Macedo

Guimarães

et al. 2022

Preprint

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Background Cardiovascular disease is the main cause of death in patients on peritoneal dialysis (PD). The standard dialysate calcium content -d[Ca]- of 1.75mmol/L affects calcium balance, promoting calcium overload and impairing ventricular relaxation. Intracellular calcium handling might cause diastolic dysfunction (DD). We tested the hypothesis that reducing d[Ca] in patients on PD would improve DD. Methods d[Ca] was reduced from 1.75 mmol/L to 1.25 mmol/L. Two-dimensional speckle-tracking echocardiography was performed by a well-trained cardiologist at baseline and after 3 months. DD was determined according to the peak E-wave and peak A-wave velocities, wave deceleration time, and the duration of wave A. Diastolic function was normal, DD-1 (impaired ventricular relaxation), and DD-2 (restrictive pattern). Demographic, clinical, and biochemical parameters were evaluated. Results We included 19 patients (age 55 ± 17 years, 57.9% women, 21.1% diabetic, 84.2% on automatic PD). From baseline to 3 months, there was no change in any biochemical parameter. Left ventricular ejection fraction remained stable (from 58.4 ± 7.7 to 56.5 ± 8.1, p=0.192). Diastolic function classified at baseline as normal, DD-1 and DD-2 changed from 21.1%, 52.6% and 26.3–31.6%, 47.4% and 21.1% after 3 months, respectively, p=0.001). Increased filling pressure changed from 21.1–5.3% of patients (p=0.051). Conclusions Low d[Ca] could improve DD in patients on PD. This result might be related to a new set point of calcium myocardium homeostasis in these patients. Whether low d[Ca] may detain the development of heart failure and reduce cardiovascular in this population deserves further investigation.

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Association of serum calcium and phosphorus with measures of left ventricular structure and function: The ARIC study

Cited by 12 publications

References 41 publications

Effect of Serum Phosphate on the Prognosis of Septic Patients: A Retrospective Study Based on MIMIC-IV Database

Effect of Serum Phosphate on the Prognosis of Septic Patients: A Retrospective Study Based on MIMIC-IV Database

Calcium: More Than Bone? Implications for Clinical Practice and Theory

The Impact of A Reduction of Dialysate Calcium on Diastolic Function in Patients on Peritoneal Dialysis: A Prospective Study

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