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. 2021 Dec 1;22(1):398.
doi: 10.1186/s12882-021-02547-z.

Higher one-year achievement rate of serum phosphate associated with lower cardiovascular mortality in hemodialysis patients

Weichen Zhang  1 , Guoxin Ye  1 , Zhaori Bi  2 , Weisheng Chen  1 , Jing Qian  1 , Minmin Zhang  1 , Ding Ding  2   3 , Mengjing Wang  4 , Jing Chen  5   6
Affiliations

Higher one-year achievement rate of serum phosphate associated with lower cardiovascular mortality in hemodialysis patients

Weichen Zhang et al. BMC Nephrol. .

Abstract

Background: Estimation of phosphate load in hemodialysis patients is always controversial in clinical practice. The aim of this study was to verify individual achievement rate of serum phosphate as the evaluation of phosphate load through investigating its impact on cardiovascular mortality in hemodialysis patients.

Methods: This was a single-center, retrospective cohort study. A total of 251 maintenance hemodialysis patients were enrolled. The individual achievement rate of serum phosphate was defined as the times of tests within the target range divided by total times of tests over a period of time. Cox regression model was used to examine the relationship between individual achievement rate of serum phosphate and cardiovascular mortality.

Results: The mean age of the study population was 61 ± 13 years old. A total of 44 (17.5%) patients died from cardiovascular disease (CVD) during a median follow-up of 65 months. Multivariable Cox analysis showed that one-year serum phosphate achievement rate of 0% (HR = 4.117, P = 0.016) and 25% (HR = 3.343, P = 0.023) increased the risk of cardiovascular mortality while the achievement rate of 50% (HR = 2.129, P = 0.162) and 75% (HR = 1.080, P = 0.902) did not, compared to the rate of 100%. Urea reduction ratio (URR) was positively, while serum intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), normalized protein catabolic rate (nPCR), and total phosphate-binding capacity of drug were negatively associated with achievement in target of serum phosphate.

Conclusions: Keeping one-year achievement rate of serum phosphate higher than 50% provides significant clinical benefits in reducing cardiovascular mortality.

Keywords: Achievement rate of serum phosphate; Cardiovascular mortality; Mineral and bone metabolism disorders; Relative weights.

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Conflict of interest statement

The authors declare that they have no relevant financial interests.

Figures

Fig. 1
Fig. 1
Association between serum phosphate indicators and CVD mortality in maintenance hemodialysis patients. Note: A Association between baseline, long-term and one-year serum phosphate indicators and CVD mortality by univariate Cox regression analysis. B Association between one-year achievement rate of serum phosphate and CVD mortality adjusted for age, diabetes mellitus, history of cardiovascular disease and one-year mean of serum albumin. HR, hazard ratio; 95%CI, 95% confidence interval. The calculation of one-year achievement rate of serum phosphate was the target-achieving times divided by the total four times in 1 year. * P < 0.05 compared to the group “One-year achievement rate of serum phosphate =100%”
Fig. 2
Fig. 2
Relative weights of related factors for target achievement of serum phosphate in single time-point examination. Note: Abbreviations: iPTH, intact parathyroid hormone; ALP, alkaline phosphatase; nPCR, normalized protein catabolic rate; URR, urea reduction ratio
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