Calcium‐phosphate product and its impact on mortality in hospitalized patients

Cheungpasitporn, Wisit; Mao, Michael A; Erickson, Stephen B.

doi:10.1111/nep.13603

Cited by 16 publications

(11 citation statements)

References 41 publications

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“…An increase in serum calcium is associated with incident heart failure [33] and possible hypercalcemia-induced neuronal injury among patients with acute ischemic stroke [34]. Moreover, an increase in serum calcium may result in AKI via renal vasoconstriction and nephrogenic diabetes insipidus-induced volume depletion [35][36][37][38][39][40]. In our current study, we also adjusted AKI during hospitalization in our multivariable logistic regression analysis, and we found that the upward trend of serum calcium change of >1.0 mg/dL was significantly associated with increased in-hospital mortality, while the highest mortality (6.3-fold increased mortality) was observed in patients with an absolute increase in serum calcium level ≥2.0 mg/dL.…”

Section: Discussionmentioning

confidence: 99%

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

et al. 2020

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Background and objectives: Calcium concentration is strictly regulated at both the cellular and systemic level, and changes in serum calcium levels can alter various physiological functions in various organs. This study aimed to assess the association between changes in calcium levels during hospitalization and mortality. Materials and Methods: We searched our patient database to identify all adult patients admitted to our hospital from January 1st, 2009 to December 31st, 2013. Patients with ≥2 serum calcium measurements during the hospitalization were included. The serum calcium changes during the hospitalization, defined as the absolute difference between the maximum and the minimum calcium levels, were categorized into five groups: 0–0.4, 0.5–0.9, 1.0–1.4, 1.5–1.9, and ≥2.0 mg/dL. Multivariable logistic regression was performed to assess the independent association between calcium changes and in-hospital mortality, using the change in calcium category of 0–0.4 mg/dL as the reference group. Results: Of 9868 patients included in analysis, 540 (5.4%) died during hospitalization. The in-hospital mortality progressively increased with higher calcium changes, from 3.4% in the group of 0–0.4 mg/dL to 14.5% in the group of ≥2.0 mg/dL (p < 0.001). When adjusted for age, sex, race, principal diagnosis, comorbidity, kidney function, acute kidney injury, number of measurements of serum calcium, and hospital length of stay, the serum calcium changes of 1.0–1.4, 1.5–1.9, and ≥2.0 mg/dL were significantly associated with increased in-hospital mortality with odds ratio (OR) of 1.55 (95% confidence interval (CI) 1.15–2.10), 1.90 (95% CI 1.32–2.74), and 3.23 (95% CI 2.39–4.38), respectively. The association remained statistically significant when further adjusted for either the lowest or highest serum calcium. Conclusion: Larger serum calcium changes in hospitalized patients were progressively associated with increased in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

et al. 2020

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“…Serum phosphate levels have been identified as strong predictors on clinical outcomes, including hospital mortality [4]. While hypophosphatemia is shown to be independently associated with increased mortality among critically ill patients, malnourished individuals, and patients with sepsis [5][6][7], hyperphosphatemia is associated with poor clinical outcomes including mortality in chronic kidney disease (CKD) [8,9], hemodialysis [10,11], acute coronary syndrome [12], and general patient population [13][14][15][16][17][18][19].…”

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confidence: 99%

Impact of serum phosphate changes on in-hospital mortality

et al. 2020

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Background Fluctuations in serum phosphate levels increased mortality in end-stage renal disease patients. However, the impacts of serum phosphate changes in hospitalized patients remain unclear. This study aimed to test the hypothesis that serum phosphate changes during hospitalization were associated with in-hospital mortality. Methods We included all adult hospitalized patients from January 2009 to December 2013 that had at least two serum phosphate measurements during their hospitalization. We categorized in-hospital serum phosphate changes, defined as the absolute difference between the maximum and minimum serum phosphate, into 5 groups: 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL. Using serum phosphate change group of 0–0.6 mg/dL as the reference group, the adjusted odds ratio of in-hospital mortality for various serum phosphate change groups was obtained by multivariable logistic regression analysis. Results A total of 28,149 patients were studied. The in-hospital mortality in patients with serum phosphate changes of 0–0.6, 0.7–1.3, 1.4–2.0, 2.1–2.7, ≥2.8 mg/dL was 1.5, 2.0, 3.1, 4.4, and 10.7%, respectively (p < 0.001). When adjusted for confounding factors, larger serum phosphate changes were associated with progressively increased in-hospital mortality with odds ratios of 1.35 (95% 1.04–1.74) in 0.7–1.3 mg/dL, 1.98 (95% CI 1.53–2.55) in 1.4–2.0 mg/dL, 2.68 (95% CI 2.07–3.48) in 2.1–2.7 mg/dL, and 5.04 (95% CI 3.94–6.45) in ≥2.8 mg/dL compared to serum phosphate change group of 0–0.6 mg/dL. A similar result was noted when we further adjusted for either the admission or mean serum phosphate during hospitalization. Conclusion Greater serum phosphate changes were progressively associated with increased in-hospital mortality.

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“…Post-KTx hypophosphatemia is known to be associated with lower risks of death-censored graft failure and cardiovascular mortality [ 85 ]. The association between post-KTx hypophosphatemia and reduced cardiovascular mortality among KTx recipients could be related to the reduction of calcium phosphate product, an important factor associated with vascular calcification and cardiovascular events [ 98 , 99 ]. Our study demonstrated that successful KTx can result in a significant increase in serum klotho levels among KTx recipients [ 85 ].…”

Section: Discussionmentioning

confidence: 99%

Serum Klotho in Living Kidney Donors and Kidney Transplant Recipients: A Meta-Analysis

Neyra

Hansrivijit

Medaura

et al. 2020

JCM

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α-Klotho is a known anti-aging protein that exerts diverse physiological effects, including phosphate homeostasis. Klotho expression occurs predominantly in the kidney and is significantly decreased in patients with chronic kidney disease. However, changes in serum klotho levels and impacts of klotho on outcomes among kidney transplant (KTx) recipients and kidney donors remain unclear. A literature search was conducted using MEDLINE, EMBASE, and Cochrane Database from inception through October 2019 to identify studies evaluating serum klotho levels and impacts of klotho on outcomes among KTx recipients and kidney donors. Study results were pooled and analyzed utilizing a random-effects model. Ten cohort studies with a total of 431 KTx recipients and 5 cohort studies with a total of 108 living kidney donors and were identified. After KTx, recipients had a significant increase in serum klotho levels (at 4 to 13 months post-KTx) with a mean difference (MD) of 243.11 pg/mL (three studies; 95% CI 67.41 to 418.81 pg/mL). Although KTx recipients had a lower serum klotho level with a MD of = −234.50 pg/mL (five studies; 95% CI −444.84 to −24.16 pg/mL) compared to healthy unmatched volunteers, one study demonstrated comparable klotho levels between KTx recipients and eGFR-matched controls. Among kidney donors, there was a significant decrease in serum klotho levels post-nephrectomy (day 3 to day 5) with a mean difference (MD) of −232.24 pg/mL (three studies; 95% CI –299.41 to −165.07 pg/mL). At one year following kidney donation, serum klotho levels remained lower than baseline before nephrectomy with a MD of = −110.80 pg/mL (two studies; 95% CI 166.35 to 55.24 pg/mL). Compared to healthy volunteers, living kidney donors had lower serum klotho levels with a MD of = −92.41 pg/mL (two studies; 95% CI −180.53 to −4.29 pg/mL). There is a significant reduction in serum klotho levels after living kidney donation and an increase in serum klotho levels after KTx. Future prospective studies are needed to assess the impact of changes in klotho on clinical outcomes in KTx recipients and living kidney donors.

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Calcium‐phosphate product and its impact on mortality in hospitalized patients

Cited by 16 publications

References 41 publications

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

Impact of serum phosphate changes on in-hospital mortality

Serum Klotho in Living Kidney Donors and Kidney Transplant Recipients: A Meta-Analysis

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