Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community based cohort study.
<h4>Background</h4>Serum phosphate is a known risk factor for cardiovascular events and mortality in people with chronic kidney disease (CKD), however data on the association of these outcomes with serum phosphate in the general population are scarce. We investigate this relationship in...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24040373/?tool=EBI |
| _version_ | 1818573359271641088 |
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| author | Andrew Peter McGovern Simon de Lusignan Jeremy van Vlymen Harshana Liyanage Charles Richard Tomson Hugh Gallagher Meena Rafiq Simon Jones |
| author_facet | Andrew Peter McGovern Simon de Lusignan Jeremy van Vlymen Harshana Liyanage Charles Richard Tomson Hugh Gallagher Meena Rafiq Simon Jones |
| author_sort | Andrew Peter McGovern |
| collection | DOAJ |
| description | <h4>Background</h4>Serum phosphate is a known risk factor for cardiovascular events and mortality in people with chronic kidney disease (CKD), however data on the association of these outcomes with serum phosphate in the general population are scarce. We investigate this relationship in people with and without CKD in a large community-based population.<h4>Methods</h4>Three groups from an adult cohort of the Quality Improvement in Chronic Kidney Disease (QICKD) cluster randomised trial (ISRCTN56023731) were followed over a period of 2.5 years: people with normal renal function (N = 24,184), people with CKD stages 1-2 (N = 20,356), and people with CKD stages 3-5 (N = 13,292). We used a multilevel logistic regression model to determine the association between serum phosphate, in these groups, and a composite outcome of all-cause mortality, cardiovascular events, and advanced coronary artery disease. We adjusted for known cardiovascular risk factors.<h4>Findings</h4>Higher phosphate levels were found to correlate with increased cardiovascular risk. In people with normal renal function and CKD stages 1-2, Phosphate levels between 1.25 and 1.50 mmol/l were associated with increased cardiovascular events; odds ratio (OR) 1.36 (95% CI 1.06-1.74; p = 0.016) in people with normal renal function and OR 1.40 (95% CI 1.09-1.81; p = 0.010) in people with CKD stages 1-2. Hypophosphatemia (<0.75 mmol/l) was associated with fewer cardiovascular events in people with normal renal function; OR 0.59 (95% CI 0.36-0.97; p = 0.049). In people with CKD stages 3-5, hyperphosphatemia (>1.50 mmol/l) was associated with increased cardiovascular risk; OR 2.34 (95% CI 1.64-3.32; p<0.001). Other phosphate ranges were not found to have a significant impact on cardiovascular events in people with CKD stages 3-5.<h4>Conclusions</h4>Serum phosphate is associated with cardiovascular events in people with and without CKD. Further research is required to determine the mechanisms underlying these associations. |
| first_indexed | 2024-12-15T00:10:07Z |
| format | Article |
| id | doaj.art-9da81629b0704b98bfb6fc81715e575c |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-15T00:10:07Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-9da81629b0704b98bfb6fc81715e575c2022-12-21T22:42:36ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0189e7499610.1371/journal.pone.0074996Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community based cohort study.Andrew Peter McGovernSimon de LusignanJeremy van VlymenHarshana LiyanageCharles Richard TomsonHugh GallagherMeena RafiqSimon Jones<h4>Background</h4>Serum phosphate is a known risk factor for cardiovascular events and mortality in people with chronic kidney disease (CKD), however data on the association of these outcomes with serum phosphate in the general population are scarce. We investigate this relationship in people with and without CKD in a large community-based population.<h4>Methods</h4>Three groups from an adult cohort of the Quality Improvement in Chronic Kidney Disease (QICKD) cluster randomised trial (ISRCTN56023731) were followed over a period of 2.5 years: people with normal renal function (N = 24,184), people with CKD stages 1-2 (N = 20,356), and people with CKD stages 3-5 (N = 13,292). We used a multilevel logistic regression model to determine the association between serum phosphate, in these groups, and a composite outcome of all-cause mortality, cardiovascular events, and advanced coronary artery disease. We adjusted for known cardiovascular risk factors.<h4>Findings</h4>Higher phosphate levels were found to correlate with increased cardiovascular risk. In people with normal renal function and CKD stages 1-2, Phosphate levels between 1.25 and 1.50 mmol/l were associated with increased cardiovascular events; odds ratio (OR) 1.36 (95% CI 1.06-1.74; p = 0.016) in people with normal renal function and OR 1.40 (95% CI 1.09-1.81; p = 0.010) in people with CKD stages 1-2. Hypophosphatemia (<0.75 mmol/l) was associated with fewer cardiovascular events in people with normal renal function; OR 0.59 (95% CI 0.36-0.97; p = 0.049). In people with CKD stages 3-5, hyperphosphatemia (>1.50 mmol/l) was associated with increased cardiovascular risk; OR 2.34 (95% CI 1.64-3.32; p<0.001). Other phosphate ranges were not found to have a significant impact on cardiovascular events in people with CKD stages 3-5.<h4>Conclusions</h4>Serum phosphate is associated with cardiovascular events in people with and without CKD. Further research is required to determine the mechanisms underlying these associations.https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24040373/?tool=EBI |
| spellingShingle | Andrew Peter McGovern Simon de Lusignan Jeremy van Vlymen Harshana Liyanage Charles Richard Tomson Hugh Gallagher Meena Rafiq Simon Jones 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 |
| title | Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community based cohort study. |
| title_full | Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community based cohort study. |
| title_fullStr | Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community based cohort study. |
| title_full_unstemmed | Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community based cohort study. |
| title_short | Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community based cohort study. |
| title_sort | serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease a large community based cohort study |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24040373/?tool=EBI |
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