Clinical Implication of Consistently Strict Phosphate Control for Coronary and Valvular Calcification in Incident Patients Undergoing Hemodialysis

Abstract

Aims: Serum phosphate control is crucial for the progression of vascular and valvular calcifications. Strict phosphate control is recently suggested; however, there is a lack of convincing evidence. Therefore, we explored the effects of strict phosphate control on vascular and valvular calcifications in incident patients undergoing hemodialysis.Methods: A total of 64 patients undergoing hemodialysis from our previous randomized controlled trial were included in this study. Coronary artery calcification score (CACS) and cardiac valvular calcification score (CVCS) were evaluated using computed tomography and ultrasound cardiography at baseline and 18 months after the initiation of hemodialysis. The absolute changes in CACS (ΔCACS) and CVCS (ΔCVCS) and the percent change in CACS (%ΔCACS) and CVCS (%ΔCVCS) were calculated. Serum phosphate level was measured at 6, 12, and 18 months after the initiation of hemodialysis. Moreover, phosphate control status was evaluated using the area under the curve (AUC) by the amount of time spent with a serum phosphate level of ≥ 4.5 mg/dL and the extent to which this threshold exceeded over the observation period.Results: ΔCACS, %ΔCACS, ΔCVCS, and %ΔCVCS were significantly lower in the low AUC group than in the high AUC group. ΔCACS and %ΔCACS were also significantly lower. ΔCVCS and %ΔCVCS tended to be lower in patients whose serum phosphate level never exceeded 4.5 mg/dL than in those whose serum phosphate level continuously exceeded 4.5 mg/dL. AUC significantly correlated with ΔCACS and ΔCVCS. Conclusion:Consistently strict phosphate control may slow the progression of coronary and valvular calcifications in incident patients undergoing hemodialysis.

Predictive nomogram model for severe coronary artery calcification in end-stage kidney disease patients

“…Furthermore, hyperphosphatemia was shown to be positively associated with CAC in patients with CKD [ 21 ]. Consistently strict phosphate control may slow the progression of coronary and valvular calcifications in incident patients undergoing hemodialysis [ 33 ]. In our study, we found that the Ca × P product was an independent risk factor for severe CAC.…”

Determination of Serum Zinc and Phosphorus Levels in Patients with Hypothyroidism

“…It was suggested that the management of serum P can play a signi cant role in weight loss in individuals and chronic diseases [11,37]. Assessment of serum P levels is essential in patients with hypothyroidism, because elevated serum phosphorus levels may increase the disease complications and be associated with microvascular dysfunction [38], coronary artery calci cation [39], chronic kidney disease [40], and cardiac arrest [41].…”

Food to Prevent Vascular Calcification in Chronic Kidney Disease

“…Yet, the benefits of phosphate-lowering medication on VC, arterial stiffness, and clinical outcomes in predialysis CKD stages remain uncertain [ 33 , 34 ]. Nevertheless, there is evidence in favor of phosphate lowering; a recent Japanese study has proven that consistently strict phosphate control may slow the progression of coronary and valvular calcifications in incident patients undergoing HD ( Table 1 ) [ 35 ].…”

“…Yet, the benefits of phosphate-lowering medication on VC, arterial stiffness, and clinical outcomes in predialysis CKD stages remain uncertain [33,34]. Nevertheless, there is evidence in favor of phosphate lowering; a recent Japanese study has proven that consistently strict phosphate control may slow the progression of coronary and valvular calcifications in incident patients undergoing HD (Table 1) [35]. RCT on 120 HD patients given supplements of vitamin K2, vitamin K1, and placebo Matrix Gla protein levels Matrix Gla protein levels showed a significant increase in the vitamin K2 group compared with vitamin K1 and placebo groups Li 2017 [44] 100 HD patients Used vitamin-K-enriched dialysate Decreased VC scores as the effect of vitamin K In PROGREDIR study on non-dialysis CKD patients, Machado et al demonstrated that an increased intake of phosphorus-and calcium-rich food is associated with coronary artery calcification (Table 1) [36].…”