DOI: http://dx.doi.org/10.18203/2349-3933.ijam20193266

Role of serum phosphate level in cardiovascular events in non-CKD patients

Arvind Kumar, Prem Singh, Mohd. Imran Khan, Mehtab Alam

Abstract


Background: Serum phosphate level correlate with atherosclerosis in both animal models and humans with advanced chronic kidney disease and coronary calcification is a known impact of higher serum phosphate, but whether this relationship exists among individuals with Non-CKD is unknown. we conducted this study to observe role of higher serum phosphate level in cardiovascular comorbidities like MI and CHF in Non-CKD patients.

Methods: In this observational study, 300 patients were enrolled, half of the patients having Clinical features or positive biochemical markers (Troponin-I for MI and serum BNP for CHF) suggestive of myocardial infarction and heart failure were taken as case group and half of the subjects were taken as control group with similar baseline characteristics. All participants in this study were consenting and more than 18 years of age.

Results: The mean value of serum phosphate level in case group was 4.41±1.40 while in control group was 3.19±1.07 showing statistically significant difference (p-value <0.001). In case group 65% patients were having MI with higher serum phosphate level (4.22±1.40).

Conclusion: Higher serum phosphate level is related to increased cardiovascular morbidities even in non-CKD patients.


Keywords


Cardiovascular morbidities, Congestive heart failure, Myocardial infraction, Serum phosphate level

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References


McGovern AP, de Lusignan S, van Vlymen J, Liyanage H, Tomson CR, Gallagher H, et al. Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community based cohort study. PLoS One. 2013:10;8(9):e74996.

Da J, Xie X, Wolf M, Disthabanchong S, Wang J, Zha Y, et al. Serum phosphorus and progression of CKD and mortality: a meta-analysis of cohort studies. Am J Kid Dis. 2015:1;66(2):258-65.

Shimada T, Hasegawa H, Yamazaki Y, Muto T, Hino R, Takeuchi Y. FGF‐23 is a potent regulator of vitamin D metabolism and phosphate homeostasis. J Bone Mineral Res. 2004;19(3):429-35.

Jono S, McKee MD, Murry CE, Shioi A, Nishizawa Y, Mori K, Morii H, Giachelli CM. Phosphate regulation of vascular smooth muscle cell calcification. Circ Res. 2000 Sep 29;87(7):e10-7.

Steitz SA, Speer MY, Curinga G, Yang HY, Haynes P, Aebersold R, Schinke T, Karsenty G, Giachelli CM. Smooth muscle cell phenotypic transition associated with calcification: upregulation of Cbfa1 and downregulation of smooth muscle lineage markers. Circ Res. 2001 Dec 7;89(12):1147-54.

Wada T, McKee MD, Steitz S, Giachelli CM. Calcification of vascular smooth muscle cell cultures: Inhibition by osteopontin. Circ Res. 1999:84(2):166-178.

Chen NX, O’Neill KD, Duan D, Moe SM. Phosphorus and uremic serum up-regulate osteopontin expression in vascular smooth muscle cells. Kidney Int. 2002;62(5):1724-31.

Luo G, Ducy P, McKee MD, Pinero GJ, Loyer E, Behringer RR, et al. Spontaneous calcification of arteries and cartilage in mice lacking matrix GLA protein. Nature. 1997;386(6620):78.

Portale AA, Halloran BP, Morris RC. Physiologic regulation of the serum concentration of 1,25-dihydroxyvitamin D by phosphorus in normal men. J Clin Invest. 1989;83(5):1494-9.

Zittermann A, Schleithoff SS, Tenderich G, Berthold HK, Korfer R, Stehle P. Low vitamin D status: a contributing factor in the pathogenesis of congestive heart failure?. J Am Coll Cardiol. 2003;41(1):105-12.

Smogorzewski MI, Zayed MA, Zhang YB, Roe JA, Massry SG. Parathyroid hormone increases cytosolic calcium concentration in adult rat cardiac myocytes. Am J Physiol Heart Circulatory Physiol. 1993:1;264(6):H1998-2006.

Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kid Dis. 1998;1;31(4):607-17.

Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK: Association of elevated serum PO (4), Ca x PO (4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001;12(10):2131-8.

Stevens LA, Djurdjev O, Cardew S, Cameron EC, Levin A. Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol. 2004 Mar 1;15(3):770-9.

Slinin Y, Foley RN, Collins AJ. Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4 study. J Am Soc Nephrol. 2005 Jun 1;16(6):1788-93.

Mautner GC, Mautner SL, Froehlich J, Feuerstein IM, Proschan MA, Roberts WC, et al. Coronary artery calcification: Assessment with electron beam CT and histomorphometric correlation. Radiol. 1994;192(3):619-23.

Detrano R, Hsiai T, Wang S, Puentes G, Fallavollita J, Shields P, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J Am Coll Cardiol. 1996;27(2):285-90.

Schmermund A, Denktas AE, Rumberger JA, Christian TF, Sheedy PF, Bailey KR, et al. Independent and incremental value of coronary artery calcium for predicting the extent of angiographic coronary artery disease: Comparison with cardiac risk factors and radionuclide perfusion imaging. J Am Coll Cardiol. 1999;34(3):777-86.

Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998;31(4):607-17.

Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO (4), Ca x PO (4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001;12(10):2131-8.

Stevens LA, Djurdjev O, Cardew S, Cameron EC, Levin A. Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: Evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol. 2004;15(3):770-9.

Slinin Y, Foley RN, Collins AJ. Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: The USRDS waves 1, 3, and 4 study. J Am Soc Nephrol. 2005;16(6):1788-93.

Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation. 2005;112(17):2627-33.