BACKGROUND: The rate of decline in kidney function is a powerful predictor of cardiovascular risk in patients with chronic kidney disease (CKD). Serum phosphate and increased arterial stiffness are associated with elevated cardiovascular risk in CKD and the general population. We sought to determine whether serum phosphate and markers of arterial stiffness predict progression of renal dysfunction in patients with early CKD. METHODS: Two hundred and twenty-five patients with Stage II-IV CKD were prospectively followed up at University Hospital Birmingham. Serum phosphate was measured at baseline and arterial stiffness was determined through measurement of aortic pulse wave velocity (PWV) and augmentation index (AIx). Progression of renal dysfunction was defined as the slope of estimated glomerular filtration rate (eGFR) against time. We determined the associations between possible predictors and rate of progression and also examined a combined end point of start of dialysis or ≥ 25% decline in eGFR. RESULTS: Mean baseline eGFR was 43 ± 19 mL/min/1.73 m(2) and serum phosphate 1.22 ± 0.27 mmol/L. Median follow-up was 924 days. Serum phosphate independently predicted a greater decline in eGFR; a 1 mmol/L increment in serum phosphate was associated with a 0.34 mL/min/month steeper decline (P = 0.02). Brachial and aortic systolic pressure independently predicted the rate of renal function decline but aortic PWV and AIx had no significant influence. Forty-one patients (18%) reached the combined end point; serum phosphate was significantly higher in this group (1.32 ± 0.36 versus 1.19 ± 0.24 mmol/L, P = 0.04) and was an independent predictor for the combined end point. CONCLUSIONS: Serum phosphate independently predicts decline in renal function in early CKD. Further studies are required to determine the mechanisms involved and to investigate the potential benefits of phosphate lowering on preserving kidney function.
BACKGROUND: The rate of decline in kidney function is a powerful predictor of cardiovascular risk in patients with chronic kidney disease (CKD). Serum phosphate and increased arterial stiffness are associated with elevated cardiovascular risk in CKD and the general population. We sought to determine whether serum phosphate and markers of arterial stiffness predict progression of renal dysfunction in patients with early CKD. METHODS: Two hundred and twenty-five patients with Stage II-IV CKD were prospectively followed up at University Hospital Birmingham. Serum phosphate was measured at baseline and arterial stiffness was determined through measurement of aortic pulse wave velocity (PWV) and augmentation index (AIx). Progression of renal dysfunction was defined as the slope of estimated glomerular filtration rate (eGFR) against time. We determined the associations between possible predictors and rate of progression and also examined a combined end point of start of dialysis or ≥ 25% decline in eGFR. RESULTS: Mean baseline eGFR was 43 ± 19 mL/min/1.73 m(2) and serum phosphate 1.22 ± 0.27 mmol/L. Median follow-up was 924 days. Serum phosphate independently predicted a greater decline in eGFR; a 1 mmol/L increment in serum phosphate was associated with a 0.34 mL/min/month steeper decline (P = 0.02). Brachial and aortic systolic pressure independently predicted the rate of renal function decline but aortic PWV and AIx had no significant influence. Forty-one patients (18%) reached the combined end point; serum phosphate was significantly higher in this group (1.32 ± 0.36 versus 1.19 ± 0.24 mmol/L, P = 0.04) and was an independent predictor for the combined end point. CONCLUSIONS: Serum phosphate independently predicts decline in renal function in early CKD. Further studies are required to determine the mechanisms involved and to investigate the potential benefits of phosphate lowering on preserving kidney function.
Authors: Marjolein Bonthuis; Marco Busutti; Karlijn J van Stralen; Kitty J Jager; Sergey Baiko; Sevcan Bakkaloğlu; Nina Battelino; Maria Gaydarova; Bruno Gianoglio; Paloma Parvex; Clara Gomes; James G Heaf; Ludmila Podracka; Dafina Kuzmanovska; Maria S Molchanova; Tatiana E Pankratenko; Fotios Papachristou; György Reusz; Maria José Sanahuja; Rukshana Shroff; Jaap W Groothoff; Franz Schaefer; Enrico Verrina Journal: Clin J Am Soc Nephrol Date: 2015-02-20 Impact factor: 8.237
Authors: Liang Li; Alexander Chang; Stephen G Rostand; Lee Hebert; Lawrence J Appel; Brad C Astor; Michael S Lipkowitz; Jackson T Wright; Cynthia Kendrick; Xuelei Wang; Tom H Greene Journal: J Am Soc Nephrol Date: 2013-11-14 Impact factor: 10.121
Authors: Raymond Vanholder; Steven Van Laecke; Griet Glorieux; Francis Verbeke; Esmeralda Castillo-Rodriguez; Alberto Ortiz Journal: Toxins (Basel) Date: 2018-06-12 Impact factor: 4.546
Authors: Luma de Oliveira Comini; Laura Camargo de Oliveira; Luiza Delazari Borges; Heloísa Helena Dias; Clara Regina Santos Batistelli; Emily de Souza Ferreira; Luciana Saraiva da Silva; Tiago Ricardo Moreira; Glauce Dias da Costa; Rodrigo Gomes da Silva; Rosângela Minardi Mitre Cotta Journal: J Clin Hypertens (Greenwich) Date: 2020-08-09 Impact factor: 3.738