A randomized controlled trial of different serum phosphate ranges in subjects on hemodialysis

Bhargava, Rama; Kalra, Philip A.; Hann, Mark; Brenchley, Paul; Hurst, Helen; Hutchison, Alastair J.

doi:10.1186/s12882-019-1216-2

Cited by 12 publications

(20 citation statements)

References 29 publications

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“…Among the patients with elevated Pi levels, 29.4% had diabetes mellitus. In comparison, of those with low Pi levels, 20.8% had diabetes mellitus (42), which was confirmed by another study (25). However, we found that the elderly patients (Group B) who had more diabetics had lower Pi levels than the younger ones (Group A).…”

Section: Discussionsupporting

confidence: 82%

Hyperphosphatemia in Haemodialyzed Patients

Romanidou

Bakaloudis

Georgoulidou

et al. 2022

PIJR

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Dietary regulation of serum phosphate levels is one of the most important therapies for the haemodialyzed patients.This is particularly difficult to apply since these patients must take huge amount of animal proteins that contain a large quantity of phosphate. However, a diet with a small amount of phosphate is required. This guideline is difficult to be implemented because patients get at least 50% of their phosphate from sources that are not obvious and from foods that are easily processed and preserved. In this retrospective study, serum levels of phosphate, calcium and parathyroid hormone were assessed in 123 haemodialyzed patients to determine their levels and differences, depending on age. Patients were grouped into two according to their age. Group A included those who were ≤ 70 years old (n = 55, 29M/26F),and Group B were those > 71 years old (n = 68,39M/29F).Higher phosphate levels were found in Group A with a statistically significant level of p < 0.0001, while overall serum phosphate levels of 47% of patients were below 4.6 mg/dl.Elderly patients with more diabetics (Group B) had lower serum phosphate levels than the younger ones (Group A).Thus, a large percentage of our patients have satisfactory serum phosphate levels, and the younger ones have less satisfactory phosphate levels,compared with the elderly.

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Section: Discussionsupporting

confidence: 82%

Hyperphosphatemia in Haemodialyzed Patients

Romanidou

Bakaloudis

Georgoulidou

et al. 2022

PIJR

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“…Nearly half of patients in the intensive group achieved their phosphate targets with calcium carbonate alone and most participants in the liberal phosphate target group achieved their target without the use of binders at all. The SPIRIT trial, which randomized 104 HD patients to a lower (2.5–4.3 mg/dL) or higher phorphorus target (5.6–7.4 mg/dL) also achieved a clinically significant sustained separation over 12 months [ 24 ]. It would have been interesting to see what role the AUC approach could have to better define the two target strategies used in this trial.…”

Section: Discussionmentioning

confidence: 99%

Impact of longer term phosphorus control on cardiovascular mortality in hemodialysis patients using an area under the curve approach: results from the DOPPS

Lopes

Karaboyas

Bieber

et al. 2020

Nephrology Dialysis Transplantation

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Background Serial assessment of phosphorus is currently recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, but its additional value versus a single measurement is uncertain. Methods We studied data from 17 414 HD patients in the Dialysis Outcomes and Practice Patterns Study, a prospective cohort study, and calculated the area under the curve (AUC) by multiplying the time spent with serum phosphorus >4.5 mg/dL over a 6-month run-in period by the extent to which this threshold was exceeded. We estimated the association between the monthly average AUC and cardiovascular (CV) mortality using Cox regression. We formally assessed whether AUC was a better predictor of CV mortality than other measures of phosphorus control according to the Akaike information criterion. Results Compared with the reference group of AUC = 0, the adjusted hazard ratio (HR) of CV mortality was 1.12 [95% confidence interval (CI) 0.90–1.40] for AUC > 0–0.5, 1.26 (95% CI 0.99–1.62) for AUC > 0.5–1, 1.44 (95% CI 1.11–1.86) for AUC > 1–2 and 2.03 (95% CI 1.53–2.69) for AUC > 2. The AUC was predictive of CV mortality within strata of the most recent phosphorus level and had a better model fit than other serial measures of phosphorus control (mean phosphorus, months out of target). Conclusions We conclude that worse phosphorus control over a 6-month period was strongly associated with CV mortality. The more phosphorus values do not exceed 4.5 mg/dL the better is survival. Phosphorus AUC is a better predictor of CV death than the single most recent phosphorus level, supporting with real-world data KDIGO’s recommendation of serial assessment of phosphorus to guide clinical decisions.

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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].…”

Section: Introductionmentioning

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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A randomized controlled trial of different serum phosphate ranges in subjects on hemodialysis

Cited by 12 publications

References 29 publications

Hyperphosphatemia in Haemodialyzed Patients

Hyperphosphatemia in Haemodialyzed Patients

Impact of longer term phosphorus control on cardiovascular mortality in hemodialysis patients using an area under the curve approach: results from the DOPPS

Impact of serum phosphate changes on in-hospital mortality

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