Hyperphosphatemia and its relationship with blood pressure, vasoconstriction, and endothelial cell dysfunction in hypertensive hemodialysis patients
Abstract Background Hyperphosphatemia occurs frequently in end-stage renal disease patients on hemodialysis and is associated with increased mortality. Hyperphosphatemia contributes to vascular calcification in these patients, but there is emerging evidence that it is also associated with endothelia...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12882-022-02918-0 |
| _version_ | 1811188863078498304 |
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| author | Jinwoo Jung Haekyung Jeon-Slaughter Hang Nguyen Jiten Patel Kamalanathan K. Sambandam Shani Shastri Peter Noel Van Buren |
| author_facet | Jinwoo Jung Haekyung Jeon-Slaughter Hang Nguyen Jiten Patel Kamalanathan K. Sambandam Shani Shastri Peter Noel Van Buren |
| author_sort | Jinwoo Jung |
| collection | DOAJ |
| description | Abstract Background Hyperphosphatemia occurs frequently in end-stage renal disease patients on hemodialysis and is associated with increased mortality. Hyperphosphatemia contributes to vascular calcification in these patients, but there is emerging evidence that it is also associated with endothelial cell dysfunction. Methods We conducted a cross-sectional study in hypertensive hemodialysis patients. We obtained pre-hemodialysis measurements of total peripheral resistance index (TPRI, non-invasive cardiac output monitor) and plasma levels of endothelin-1 (ET-1) and asymmetric dimethylarginine (ADMA). We ascertained the routine peridialytic blood pressure (BP) measurements from that treatment and the most recent pre-hemodialysis serum phosphate levels. We used generalized linear regression analyses to determine independent associations between serum phosphate with BP, TPRI, ET-1, and ADMA while controlling for demographic variables, parathyroid hormone (PTH), and interdialytic weight gain. Results There were 54 patients analyzed. Mean pre-HD supine and seated systolic and diastolic BP were 164 (27), 158 (21), 91.5 (17), and 86.1 (16) mmHg. Mean serum phosphate was 5.89 (1.8) mg/dL. There were significant correlations between phosphate with all pre-hemodialysis BP measurements (r = 0.3, p = .04; r = 0.4, p = .002; r = 0.5, p < .0001; and r = 0.5, p = .0003.) The correlations with phosphate and TPRI, ET-1, and ADMA were 0.3 (p = .01), 0.4 (p = .007), and 0.3 (p = .04). In our final linear regression analyses controlling for baseline characteristics, PTH, and interdialytic weight gain, independent associations between phosphate with pre-hemodialysis diastolic BP, TPRI, and ET-1 were retained (β = 4.33, p = .0002; log transformed β = 0.05, p = .005; reciprocal transformed β = -0.03, p = .047). Conclusions Serum phosphate concentration is independently associated with higher pre-HD BP, vasoconstriction, and markers of endothelial cell dysfunction. These findings demonstrate an additional negative impact of hyperphosphatemia on cardiovascular health beyond vascular calcification. Trial registration The study was part of a registered clinical trial, NCT01862497 (May 24, 2013). |
| first_indexed | 2024-04-11T14:26:18Z |
| format | Article |
| id | doaj.art-2e02c4f93103480e887ea9a39965cbc2 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-11T14:26:18Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-2e02c4f93103480e887ea9a39965cbc22022-12-22T04:18:51ZengBMCBMC Nephrology1471-23692022-08-012311810.1186/s12882-022-02918-0Hyperphosphatemia and its relationship with blood pressure, vasoconstriction, and endothelial cell dysfunction in hypertensive hemodialysis patientsJinwoo Jung0Haekyung Jeon-Slaughter1Hang Nguyen2Jiten Patel3Kamalanathan K. Sambandam4Shani Shastri5Peter Noel Van Buren6Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical CenterDepartment of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical CenterDepartment of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical CenterDepartment of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical CenterDepartment of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical CenterDepartment of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical CenterDepartment of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical CenterAbstract Background Hyperphosphatemia occurs frequently in end-stage renal disease patients on hemodialysis and is associated with increased mortality. Hyperphosphatemia contributes to vascular calcification in these patients, but there is emerging evidence that it is also associated with endothelial cell dysfunction. Methods We conducted a cross-sectional study in hypertensive hemodialysis patients. We obtained pre-hemodialysis measurements of total peripheral resistance index (TPRI, non-invasive cardiac output monitor) and plasma levels of endothelin-1 (ET-1) and asymmetric dimethylarginine (ADMA). We ascertained the routine peridialytic blood pressure (BP) measurements from that treatment and the most recent pre-hemodialysis serum phosphate levels. We used generalized linear regression analyses to determine independent associations between serum phosphate with BP, TPRI, ET-1, and ADMA while controlling for demographic variables, parathyroid hormone (PTH), and interdialytic weight gain. Results There were 54 patients analyzed. Mean pre-HD supine and seated systolic and diastolic BP were 164 (27), 158 (21), 91.5 (17), and 86.1 (16) mmHg. Mean serum phosphate was 5.89 (1.8) mg/dL. There were significant correlations between phosphate with all pre-hemodialysis BP measurements (r = 0.3, p = .04; r = 0.4, p = .002; r = 0.5, p < .0001; and r = 0.5, p = .0003.) The correlations with phosphate and TPRI, ET-1, and ADMA were 0.3 (p = .01), 0.4 (p = .007), and 0.3 (p = .04). In our final linear regression analyses controlling for baseline characteristics, PTH, and interdialytic weight gain, independent associations between phosphate with pre-hemodialysis diastolic BP, TPRI, and ET-1 were retained (β = 4.33, p = .0002; log transformed β = 0.05, p = .005; reciprocal transformed β = -0.03, p = .047). Conclusions Serum phosphate concentration is independently associated with higher pre-HD BP, vasoconstriction, and markers of endothelial cell dysfunction. These findings demonstrate an additional negative impact of hyperphosphatemia on cardiovascular health beyond vascular calcification. Trial registration The study was part of a registered clinical trial, NCT01862497 (May 24, 2013).https://doi.org/10.1186/s12882-022-02918-0PhosphateHemodialysisEndothelial cell dysfunctionMineral bone diseaseVasoconstriction |
| spellingShingle | Jinwoo Jung Haekyung Jeon-Slaughter Hang Nguyen Jiten Patel Kamalanathan K. Sambandam Shani Shastri Peter Noel Van Buren Hyperphosphatemia and its relationship with blood pressure, vasoconstriction, and endothelial cell dysfunction in hypertensive hemodialysis patients BMC Nephrology Phosphate Hemodialysis Endothelial cell dysfunction Mineral bone disease Vasoconstriction |
| title | Hyperphosphatemia and its relationship with blood pressure, vasoconstriction, and endothelial cell dysfunction in hypertensive hemodialysis patients |
| title_full | Hyperphosphatemia and its relationship with blood pressure, vasoconstriction, and endothelial cell dysfunction in hypertensive hemodialysis patients |
| title_fullStr | Hyperphosphatemia and its relationship with blood pressure, vasoconstriction, and endothelial cell dysfunction in hypertensive hemodialysis patients |
| title_full_unstemmed | Hyperphosphatemia and its relationship with blood pressure, vasoconstriction, and endothelial cell dysfunction in hypertensive hemodialysis patients |
| title_short | Hyperphosphatemia and its relationship with blood pressure, vasoconstriction, and endothelial cell dysfunction in hypertensive hemodialysis patients |
| title_sort | hyperphosphatemia and its relationship with blood pressure vasoconstriction and endothelial cell dysfunction in hypertensive hemodialysis patients |
| topic | Phosphate Hemodialysis Endothelial cell dysfunction Mineral bone disease Vasoconstriction |
| url | https://doi.org/10.1186/s12882-022-02918-0 |
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