Calcium, Phosphorus, Parathyroid Hormone, and Cardiovascular Disease in Hemodialysis Patients: The USRDS Waves 1, 3, and 4 Study

Slinin, Yelena; Foley, Robert N.; Collins, Allan J.

doi:10.1681/asn.2004040275

Cited by 389 publications

(344 citation statements)

References 23 publications

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“…The more severe hyperparathyroidism among Blacks and South Asians may therefore be a physiologic adaptive response to maintain bone turnover. Previous studies have reported associations between high PTH and all-cause mortality (51)(52) and cardiovascular-and fracture-related hospitalizations (52), but this was observed only at PTH levels of Ͼ480 pg/ml (52), and Ͼ600 pg/ml (51), much higher than the KDOQI recommended target of 150 to 300 pg/ml. It is also not clear if the PTH levels at which the mortality, hospitalization, and fracture-risk increases vary between ethnic groups.…”

Section: Discussionmentioning

confidence: 89%

Ethnicity, Socioeconomic Status, and Attainment of Clinical Practice Guideline Standards in Dialysis Patients in the United Kingdom

Udayaraj¹,

Ben‐Shlomo²,

Roderick³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: The role of socioeconomic status (SES) and its contribution to ethnic differences in standards attainment among dialysis patients is not known.Design, setting, participants, & measurements: We examined associations between area-level SES (Townsend index) and ethnicity (white, black, South Asian) and standards attainment in 14,117 incident dialysis patients (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) in the UK.Results: Deprived patients were less likely to achieve hemoglobin (Hb) > 10g/dl (trend P < 0.001) but not after controlling for patient and center characteristics (trend P ‫؍‬ 0.1). There was no association with hemodialysis dose and parathyroid hormone (PTH) standard but deprived patients had better attainment of phosphate (PO4) <5.6 mg/dl, calcium (Ca) and Calcium-phosphate (CaPO4) standard (e.g., most deprived versus least deprived adjusted odds ratio [OR] 1.25, 95% confidence intervals [CI] 1.12, 1.38). There was no association with SES using a lower limit for PO4 (3.5 ؊ 5.5 mg/dl). Compared with Whites, Blacks had lower attainment of Hb (adjusted OR 0.57, 95% CI 0.45, 0.71) and PTH standards (adjusted OR 0.27, 95% CI 0.22, 0.33) but better attainment of PO4 and CaPO4, while South Asians experienced better or comparable outcomes for most standards except Ca and PTH.Conclusions: There was no evidence of socioeconomic inequity in standards attainment or a consistent pattern of inequity by ethnic group. The lower attainment of some standards in ethnic minorities may reflect biologic differences rather than ethnicity-related inequity of care.

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Section: Discussionmentioning

confidence: 89%

Ethnicity, Socioeconomic Status, and Attainment of Clinical Practice Guideline Standards in Dialysis Patients in the United Kingdom

Udayaraj¹,

Ben‐Shlomo²,

Roderick³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…Hyperphosphatemia is a well known risk factor for all-cause and cardiovascular mortality in HD patients (27)(28)(29). It has been associated with secondary hyperparathyroidism, renal osteodystrophy, and with the development of vascular calcifications (30).…”

Section: Discussionmentioning

confidence: 99%

Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Penne

Weerd

Grooteman

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives There is increasing awareness that residual renal function (RRF) has beneficial effects in hemodialysis (HD) patients. The aim of this study was to investigate the role of RRF, expressed as GFR, in phosphate and anemia management in chronic HD patients.Design, setting, participants, & measurements Baseline data of 552 consecutive patients from the Convective Transport Study (CONTRAST) were analyzed. Patients with a urinary output Ն100 ml/24 h (n ϭ 295) were categorized in tertiles on the basis of degree of GFR and compared with anuric patients (i.e., urinary output Ͻ100 ml/24 h, n ϭ 274). Relations between GFR and serum phosphate and erythropoiesis-stimulating agent (ESA) index (weekly ESA dose per kg body weight divided by hematocrit) were analyzed with multivariable regression models.Results Phosphate levels were between 3.5 and 5.5 mg/dl in 68% of patients in the upper tertile (GFR Ͼ 4.13 ml/min per 1.73 m 2 ), as compared with 46% in anuric patients despite lower prescription of phosphate-binding agents. Mean hemoglobin levels were 11.9 Ϯ 1.2 g/dl with no differences between the GFR categories. The ESA index was 31% lower in patients in the upper tertile as compared with anuric patients. After adjustments for patient characteristics, patients in the upper tertile had significantly lower serum phosphate levels and ESA index as compared with anuric patients. ConclusionsThis study suggests a strong relation between RRF and improved phosphate and anemia control in HD patients. Efforts to preserve RRF in HD patients could improve outcomes and should be encouraged.

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“…104 Phosphate toxicity RB Brown et al have shown that hypercalcemia may have predictive value in determining the negative outcome of CKD patients. 85 Although phosphate toxicity is known to promote disease progression in patients with CKD, its association with tumorigenesis is not studied in similar depth and detail. We next present evidence of this association and suggest some innovative theories of tumorigenesis.…”

Section: Phosphate Toxicity Associated With Ckdmentioning

confidence: 99%

Dysregulation of phosphate metabolism and conditions associated with phosphate toxicity

Brown

2015

BoneKEy Reports

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Phosphate homeostasis is coordinated and regulated by complex cross-organ talk through delicate hormonal networks. Parathyroid hormone (PTH), secreted in response to low serum calcium, has an important role in maintaining phosphate homeostasis by influencing renal synthesis of 1,25-dihydroxyvitamin D, thereby increasing intestinal phosphate absorption. Moreover, PTH can increase phosphate efflux from bone and contribute to renal phosphate homeostasis through phosphaturic effects. In addition, PTH can induce skeletal synthesis of another potent phosphaturic hormone, fibroblast growth factor 23 (FGF23), which is able to inhibit renal tubular phosphate reabsorption, thereby increasing urinary phosphate excretion. FGF23 can also fine-tune vitamin D homeostasis by suppressing renal expression of 1-alpha hydroxylase (1a(OH)ase). This review briefly discusses how FGF23, by forming a bone-kidney axis, regulates phosphate homeostasis, and how its dysregulation can lead to phosphate toxicity that induces widespread tissue injury. We also provide evidence to explain how phosphate toxicity related to dietary phosphorus overload may facilitate incidence of noncommunicable diseases including kidney disease, cardiovascular disease, cancers and skeletal disorders.

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Calcium, Phosphorus, Parathyroid Hormone, and Cardiovascular Disease in Hemodialysis Patients: The USRDS Waves 1, 3, and 4 Study

Cited by 389 publications

References 23 publications

Ethnicity, Socioeconomic Status, and Attainment of Clinical Practice Guideline Standards in Dialysis Patients in the United Kingdom

Ethnicity, Socioeconomic Status, and Attainment of Clinical Practice Guideline Standards in Dialysis Patients in the United Kingdom

Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Dysregulation of phosphate metabolism and conditions associated with phosphate toxicity

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