Parathormon, Calcium, Phosphorus, and Left Ventricular Structure and Function in Normotensive Hemodialysis Patients

Stróżecki, Paweł; Adamowicz, Andrzej; Nartowicz, E; Odrowąż-Sypniewska, Grażyna; Włodarczyk, Zbigniew; Manitius, Jacek

doi:10.1081/jdi-100001291

Cited by 93 publications

(75 citation statements)

References 31 publications

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“…Poor control of mineral metabolism also has been associated with functional and structural cardiac abnormalities (9,10,24). We recently provided evidence, for the first time, that improvement of serum phosphorus during the period of 1 yr is associated with reduction in LVMI in hemodialysis patients (11).…”

Section: Resultsmentioning

confidence: 90%

Left Ventricular Hypertrophy

Achinger

Ayus

2006

Journal of the American Society of Nephrology

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Cardiovascular disease occurs in ESRD patients at rates that are far higher than is seen in the general population, and cardiovascular deaths account for the majority of deaths among dialysis patients. Abnormal mineral metabolism is a novel cardiovascular risk factor among dialysis patients. Recently published results demonstrated that even with good control of BP and anemia, conventional hemodialysis is associated with significant left ventricular hypertrophy (LVH); however, daily hemodialysis was associated with a significant reduction in LV mass index (LVMI). Furthermore, it was shown that control of serum phosphorus correlates with the reduction in LVMI. These data suggest a novel mechanism for the deleterious effect of elevated serum phosphorus on cardiovascular outcomes among hemodialysis patients: LVH. Other investigators have noted an association of hyperphosphatemia and LVH; however, this study was the first to demonstrate that improvement in serum phosphorus is associated with reduction in LVM. In addition, it is shown that daily hemodialysis is an effective modality in improving serum phosphorus through significantly improved phosphorus removal. Elevated serum phosphorus leads to vascular calcification, which can lead to LVH by decreasing vascular compliance. However, our study showed an improvement in LVMI during a 12-mo period. Because vascular calcification is unlikely to remit over this time period, it is proposed that serum phosphorus has a reversible, cardiotoxic effect that leads to LVH that can be reversed successfully with good control of serum phosphorus.

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Section: Resultsmentioning

confidence: 90%

Left Ventricular Hypertrophy

Achinger

Ayus

2006

Journal of the American Society of Nephrology

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“…Other CKD-related disturbances can also potentially explain the association. Serum phosphate level has been associated with CKD progression (6) and left ventricular hypertrophy (20), which are known to contribute to cardiovascular disease and death. Our results confirm an association of increasing phosphate with declining eGFR.…”

Section: Discussionmentioning

confidence: 99%

Serum Phosphate and Mortality in Patients with Chronic Kidney Disease

Eddington

Hoefield²,

Sinha³

et al. 2010

Clinical Journal of the American Society of Nephrology

205

149

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Background and objectives: Higher phosphate is associated with mortality in dialysis patients but few prospective studies assess this in nondialysis patients managed in an outpatient nephrology clinic. This prospective longitudinal study examined whether phosphate level was associated with death in a referred population. Conclusions: In CKD stages 3 to 4 patients, higher phosphate was associated with a stepwise increase in mortality. As phosphate levels below published targets (as opposed to within them) are associated with better survival, guidelines for phosphate in nondialysis CKD patients should be re-examined. Intervention trials are required to determine whether lowering phosphate will improve survival.

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“…There are also concerns that phosphorus might induce direct actions on the myocardium, inducing fibrosis (18). Although there have been in vitro studies demonstrating this, direct clinical evidence has been provided by studies that have linked hyperphosphatemia to left ventricular hypertrophy, both in CKD (19) and ESRD patients (20). There is also an association between higher serum phosphorus and arterial compliance (21), which may indirectly lead to left ventricular hypertrophy.…”

Section: Association Between Serum Phosphorus and Cvdmentioning

confidence: 99%

Phosphorus and the Kidney: What Is Known and What Is Needed

Nadkarni

Uribarri

2014

Advances in Nutrition

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A major role of the kidneys is to maintain phosphorus homeostasis. High serum phosphorus has been linked to all-cause and cardiovascular mortality in chronic kidney disease (CKD) both before and after initiation of renal replacement therapy. Considering the clinical implications of uncontrolled hyperphosphatemia, maintenance of phosphorus concentrations within an optimum range is standard of care in this patient population. Recently, the epidemiologic associations between serum phosphorus and worse outcome have been extended to the general population. This becomes even more important in view of the increasing dietary phosphorus intake in the American diet due in large part to the greater consumption of foods processed with phosphate additives. A greater understanding of mechanisms and epidemiology of altered phosphorus metabolism and disease in CKD may help clarify the possible role of excess dietary phosphorus as a health risk factor in the general population. Adv. Nutr. 5: 98-103, 2014.

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Parathormon, Calcium, Phosphorus, and Left Ventricular Structure and Function in Normotensive Hemodialysis Patients

Cited by 93 publications

References 31 publications

Left Ventricular Hypertrophy

Left Ventricular Hypertrophy

Serum Phosphate and Mortality in Patients with Chronic Kidney Disease

Phosphorus and the Kidney: What Is Known and What Is Needed

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