High plasma phosphate as a risk factor for decline in renal function and mortality in pre-dialysis patients

Voormolen, Nora; Noordzij, Marlies; Grootendorst, Diana C.; Beetz, Ivo; Sijpkens, Yvo W.J.; Manen, Jeannette G. van; Boeschoten, Elisabeth W.; Huisman, Roel M.; Krediet, Raymond T.; Dekker, Friedo W.

doi:10.1093/ndt/gfm286

Cited by 281 publications

(228 citation statements)

References 32 publications

Supporting

Mentioning

217

Contrasting

Unclassified

Order By: Relevance

“…6,7 We 8 and others 9 have demonstrated that serum phosphate predicts graft survival posttransplant. This finding, however, has not been universal, with other investigators demonstrating no association.…”

Section: Introductionmentioning

confidence: 91%

Serum Phosphate Measured at 6 and 12 Months After Successful Kidney Transplant Is Independently Associated With Subsequent Graft Loss

Benavente¹,

Chue²,

Moore³

et al. 2012

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: Serum phosphate concentrations have been shown to predict graft loss in prevalent, but not incident, kidney transplant populations. The reasons for this are unknown. We investigated whether serum phosphate at 6 or 12 months posttransplant was associated with graft loss in the same cohort. Materials and Methods: Data were collected for 325 patients transplanted and followed up at a single center (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). The association between serum phosphate at 6 and 12 months posttransplant and graft failure was analyzed. Results: Univariable associations with deathcensored graft failure were seen for serum phosphate at 6 and 12 months (hazard ratio [HR] 1.33; 95% confidence interval [CI] 1.20-1.48; P < .001, and HR 1.40; CI 1.27-1.54; P < .001). On bivariable analysis (phosphate at 6 vs 12 mo), a significant association remained for both variables and increased graft failure rate (HR 1.19; CI 1.07-1.34; P = .002, and HR 1.37; CI 1.21-1.55; P < .001). These associations persisted in multivariable models (HR 1.27; CI 1.07-1.51; P = .007, and HR 1.34; CI 1.14-1.57; P < .001 for phosphate at 6 and 12 mo). Conclusions: Serum phosphate at 6 and 12 months posttransplant is an independent predictor of graft loss. Any future trial designed to investigate the benefits of phosphate lowering should consider recruiting patients as early as 6 months posttransplant.

show abstract

Section: Introductionmentioning

confidence: 91%

Serum Phosphate Measured at 6 and 12 Months After Successful Kidney Transplant Is Independently Associated With Subsequent Graft Loss

Benavente¹,

Chue²,

Moore³

et al. 2012

Exp Clin Transplant

View full text Add to dashboard Cite

show abstract

“…The results from the present study demonstrated that hyperphosphatemia was an independent risk factor influencing the development of SPTH. Voormolen et al (26) reported that elevated plasma phosphorus directly stimulates the synthesis and secretion of PTH in patients with stage 4-5 CKD. The effect of plasma phosphorus is independent of the level of plasma calcium or the activation of vitamin D. The results in the current study were in line with this report, indicating that hyperphosphatemia is an independent risk factor affecting renal function in patients with CKD.…”

Section: % CI ------------------------------Variablementioning

confidence: 99%

Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease

Wei

Lin

Yang

et al. 2016

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Abstract. Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD), and its development and progression are affected by various factors. The aim of the present study was to identify the risk factors for SHPT in patients with CKD. A retrospective study was performed in 498 patients (305 males and 193 females) with CKD, observed in the The First Hospital of Jilin University between January 2008 and December 2012. The demographic, clinical and laboratory data were collected. Patients were divided into the SHPT group (n=424) with elevated serum parathyroid hormone (PTH) expression levels and the control group (n=74) with normal serum PTH expression levels. Univariate and multivariate regression analyses were employed to explore the risk factors for SHPT. Serum PTH expression levels in women with CKD were significantly higher than in men (P= 0.047). Serum PTH expression levels were positively correlated with the expression levels of serum creatinine (P<0.01), phosphorus (P<0.01), C-reactive protein (P<0.05), triglyceride (P<0.05), cholesterol (P<0.05) and low-density lipoprotein cholesterol (P<0.05), but were negatively correlated with the expression levels of hemoglobin (P<0.05), calcium (P<0.01) and CO 2 combining power (P<0.01) in patients with CKD. Multivariate analysis showed that the serum expression levels of creatinine [µmol/l; odds radio (OR), 1.003; 95% confidence interval (CI), 1.002-1.004; P=0.001] and phosphorus (mmol/l; OR, 2.19; 95% CI, 1.254-3.826; P=0.006) in patients with CKD significantly influenced serum PTH expression levels. The SHPT risk factors include female gender, low calcium, high phosphorus, acidosis, anemia, hypertension, hyperlipidemia and micro-inflammation, with blood phosphorus and creatinine being independent risk factors. IntroductionThe incidence of chronic kidney disease (CKD) is rapidly increasing, posing a serious health problem worldwide. More than 16 million adults are affected by end stage CKD in the USA (1,2). Abnormal serum calcium, phosphorus and parathyroid hormone (PTH) expression levels are common challenges in the management of CKD (3,4). These biochemical abnormalities, together with the dysregulation of vitamin D metabolism and bone turnover, constitute a systemic syndrome termed CKD mineral and bone disorder (CKD-MBD) (5).Secondary hyperparathyroidism (SHPT) is a common complication of patients with CKD, which is characterized by increased blood PTH levels, and abnormal mineral and bone metabolism (6). It is associated with increased morbidity and mortality, and adversely influences the quality of life of patients with CKD (3,6). The incidence of SHPT is reported to increase with the stage of CKD: 40% in stage 3, 70% in stage 4 and >80% in stage 5 (4,7).The kidneys are vital organs regulating calcium and phosphorous homeostasis (8). SHPT is an adaptive pathophysiological process in response to deteriorating renal insufficiency (6). The fundamental mechanism of PTH in kidneys is to suppress the reabsorption of phosphate in the pro...

show abstract

“…Evidence suggests that hyperphosphatemia is actively involved in the pathogenesis of vascular calcification (8 -10). In addition, evidence associating elevated serum phosphorus with morbidity and mortality is strong, including several large observational studies in patients with CKD who had not yet required dialysis (4,(11)(12)(13). Kidney Disease Outcomes Quality Initiative guidelines recommend that serum phosphorus should be maintained within the reference range in patients with CKD stages 3 and 4 (14).…”

mentioning

confidence: 99%

Lanthanum Carbonate Reduces Phosphorus Burden in Patients with CKD Stages 3 and 4

Sprague¹,

Abboud²,

Qiu³

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

High plasma phosphate as a risk factor for decline in renal function and mortality in pre-dialysis patients

Abstract: High plasma phosphate is an independent risk factor for a more rapid decline in renal function and a higher mortality during the pre-dialysis phase. Plasma phosphate within the normal range is likely of vital importance in pre-dialysis patients.

Cited by 281 publications

References 32 publications

Serum Phosphate Measured at 6 and 12 Months After Successful Kidney Transplant Is Independently Associated With Subsequent Graft Loss

Serum Phosphate Measured at 6 and 12 Months After Successful Kidney Transplant Is Independently Associated With Subsequent Graft Loss

Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease

Lanthanum Carbonate Reduces Phosphorus Burden in Patients with CKD Stages 3 and 4

Contact Info

Product

Resources

About