Serum Phosphorus Levels are Associated with Intradialytic Hypotension in Hemodialysis Patients

Background: Intradialytic hypotension (IDH) is a common serious complication in hemodialysis (HD) patients. Hyperphosphatemia is also common in HD patients and promotes vascular calcification. Given the association between vascular calcification and IDH, we investigated the association between IDH and serum phosphorus in HD patients. Methods: We enrolled 173 patients who received HD for 3 months or more. IDH was defined as a nadir systolic blood pressure (SBP) <90 mm Hg or as a decrease in SBP ≥20 mm Hg or a decrease in mean arterial pressure by 10 mm Hg with the occurrence of hypotension-related symptoms requiring intervention. Serum phosphorus levels were analyzed both as a continuous variable and as a categorical variable. Results: IDH occurred in 40 (23.1%) of the 173 patients. The mean phosphorus level was 4.9 mg/dL. A 1 mg/dL higher serum phosphorus resulted in a 2.1-fold greater odds of IDH. The fully adjusted odds ratio (OR) and 95% confidence interval (CI) were 2.11 (1.48–3.01). High categorized phosphorus levels were also associated with IDH. The highest tertile of serum phosphorus was associated with 6.5-fold greater odds of developing IDH compared to the referent group (the middle tertile of serum phosphorus, 4.0–<5.3 mg/dL); the fully adjusted OR (95% CIs) were 6.53 (2.23–19.09). In subgroup analyses, diabetes and pre-dialysis SBP modified the association between IDH and phosphorus levels, with a more pronounced association in diabetic patients and pre-dialysis SBP ≥140 mm Hg. Conclusion: In HD patients, higher phosphorus levels were associated with an increased occurrence of IDH.

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Therapeutic Effects of Add-On Tenapanor for Hemodialysis Patients with Refractory Hyperphosphatemia

American Journal of Nephrology ◽

10.1159/000516156 ◽

2021 ◽

pp. 1-11

Author(s):

Takashi Shigematsu ◽

Yotaro Une ◽

Kazuaki Ikejiri ◽

Hironori Kanda ◽

Masafumi Fukagawa ◽

...

Keyword(s):

Placebo Group ◽

Hemodialysis Patients ◽

Serum Phosphorus ◽

Phosphate Binders ◽

Therapeutic Effects ◽

Efficacy And Safety ◽

Phosphorus Level ◽

Serum Phosphorus Level ◽

The Mean ◽

Phosphorus Levels

Introduction: Phosphate binders are used to treat hyperphosphatemia. Some patients have inappropriately controlled serum phosphorus levels, which may occur for many reasons, including a high pill burden and adverse events (AEs). Tenapanor selectively inhibits the passive paracellular transfer of phosphate in the gastrointestinal tract, thereby reducing serum phosphorus levels. This novel mechanism of action may contribute to improved phosphate management. The efficacy and safety of tenapanor have not been evaluated in Japanese patients with high serum phosphorus levels despite treatment with phosphate binders. This study aimed to assess the efficacy and safety of add-on tenapanor therapy for reducing serum phosphorus levels in this population. Methods: This multicenter, double-blind, randomized, placebo-controlled trial enrolled patients with refractory hyperphosphatemia undergoing hemodialysis. Patients were randomly assigned in a 1:1 ratio to receive tenapanor or placebo as an add-on to their phosphate binder regimen for 6 weeks. Change in serum phosphorus levels at week 6 (day 43) compared with the baseline value (day 1, week 0) (primary endpoint), achievement of target serum phosphorus levels (serum phosphorus level ≤6.0 or ≤5.5 mg/dL), and safety, based on all AEs and drug-related AEs, were among the outcomes evaluated. Results: In total, 24 patients were randomly assigned to the placebo group and 23 to the tenapanor group. The mean serum phosphorus level decreased from 7.01 mg/dL on day 1 to 6.69 mg/dL on day 43 in the placebo group and from 6.77 mg/dL on day 1 to 4.67 mg/dL on day 43 in the tenapanor group. In the placebo and tenapanor groups (modified intent-to-treat population), the mean (standard deviation) change in the serum phosphorus level at day 43 (last observation carried forward [LOCF]) was 0.08 (1.52) mg/dL and −1.99 (1.24) mg/dL, respectively, with a between-group difference of −2.07 (95% confidence interval: −2.89, −1.26; p < 0.001). The target achievement rate (serum phosphorus level ≤6.0 mg/dL at week 6 [LOCF]) was 37.5 and 87.0% in the placebo and tenapanor groups, respectively. Diarrhea was the most common drug-related AE, and it occurred in 8.3 and 65.2% of patients in the placebo and tenapanor groups, respectively. No specific AEs were observed with add-on tenapanor or with phosphate binders. Discussion/Conclusion: Therapy with existing phosphate binders and add-on tenapanor resulted in a significant decrease in serum phosphorus level compared with the placebo group in patients with refractory hyperphosphatemia despite treatment with phosphate binders. No new safety signals were raised, and add-on tenapanor was generally well tolerated.

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Correlation between hypophosphatemia and the severity of Corona Virus Disease 2019 patients

10.1101/2020.03.27.20040816 ◽

2020 ◽

Author(s):

Xiaobo Xue ◽

Jing Ma ◽

Yuxia Zhao ◽

Aibin Zhao ◽

Xiaohong Liu ◽

...

Keyword(s):

Virus Disease ◽

Common Type ◽

Serum Phosphorus ◽

Phosphorus Level ◽

Serum Phosphorus Level ◽

Absolute Value ◽

Corona Virus ◽

Significant Difference ◽

Critical Patients ◽

Phosphorus Levels

AbstractObjectiveRetrospectively analyze the clinical data of Corona Virus Disease 2019 (COVID-19) patients and explore the value of serum phosphorus level in evaluating the severity and prognosis of the disease.MethodsCOVID-19 patients transferred from the first emergency ward of Taiyuan fourth people’s Hospital from February 8 to March 3, 2020 were enrolled. The information of general conditions, clinical manifestations, laboratory indexes, nucleic acid detection and treatment were collected. The changes of blood phosphorus level and absolute value of lymphocytes in ordinary and severe/critical patients were recorded and compared.ResultsA total of 32 patients with COVID-19 were collected, including 12 cases of common type and 20 cases of severe/critical type. Before treatment, the serum phosphorus levels of the two groups were significantly lower than the normal level, and the serum phosphorus levels of the severe/critical patients were lower than those of the common type patients (t = 2.767, P < 0.010). After treatment, the serum phosphorus levels of the two groups reached normal, and there was no significant difference between the two groups (t = 0.231, P >0.819). The level of lymphocytes in severe/critical patients was lower than that in normal patients (t = 4.636, P < 0.001) before treatment. After treatment, the absolute value of lymphocytes in the two groups reached normal, and there was no significant difference between the two groups (t=1.208,P=0.237). There was a positive correlation between lymphocytes and serum phosphorus, and the correlation coefficient was 0.479.Conclusionhypophosphatemia is related to the severity of COVID-19, and strengthening the monitoring of serum phosphorus level of COVID-19’s severe/critical patients and correcting hypophosphatemia in time are of significance to improve the prognosis.

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Effect of Neighborhood Food Environment and Socioeconomic Status on Serum Phosphorus Level for Patients on Chronic Dialysis

Journal of the American Society of Nephrology ◽

10.1681/asn.2020030290 ◽

2020 ◽

Vol 31 (11) ◽

pp. 2622-2630

Author(s):

Vishnu S. Potluri ◽

Deirdre Sawinski ◽

Vicky Tam ◽

Justine Shults ◽

Jordana B. Cohen ◽

...

Keyword(s):

Socioeconomic Status ◽

Food Environment ◽

Healthy Food ◽

Chronic Dialysis ◽

Serum Phosphorus ◽

Phosphorus Level ◽

Serum Phosphorus Level ◽

Neighborhood Food Environment ◽

Neighborhood Income ◽

Phosphorus Levels

BackgroundElevated blood phosphorus levels are common and associated with a greater risk of death for patients receiving chronic dialysis. Phosphorus-rich foods are prevalent in the American diet, and low-phosphorus foods, including fruits and vegetables, are often less available in areas with more poverty. The relative contributions of neighborhood food availability and socioeconomic status to phosphorus control in patients receiving dialysis are unknown.MethodsUsing longitudinal data from a national dialysis provider, we constructed hierarchical, linear mixed-effects models to evaluate the relationships between neighborhood food environment or socioeconomic status and serum phosphorus level among patients receiving incident dialysis.ResultsOur cohort included 258,510 patients receiving chronic hemodialysis in 2005–2013. Median age at dialysis initiation was 64 years, 45% were female, 32% were Black, and 15% were Hispanic. Within their residential zip code, patients had a median of 25 “less-healthy” food outlets (interquartile range, 11–40) available to them compared with a median of four “healthy” food outlets (interquartile range, 2–6). Living in a neighborhood with better availability of healthy food was not associated with a lower phosphorus level. Neighborhood income also was not associated with differences in phosphorus. Patient age, race, cause of ESKD, and mean monthly dialysis duration were most closely associated with phosphorus level.ConclusionsNeither neighborhood availability of healthy food options nor neighborhood income was associated with phosphorus levels in patients receiving chronic dialysis. Modifying factors, such as nutrition literacy, individual-level financial resources, and adherence to diet restrictions and medications, may be more powerful contributors than food environment to elevated phosphorus.

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Real-World Scenario Improvements in Serum Phosphorus Levels and Pill Burden in Peritoneal Dialysis Patients Treated with Sucroferric Oxyhydroxide

American Journal of Nephrology ◽

10.1159/000487856 ◽

2018 ◽

Vol 47 (3) ◽

pp. 153-161 ◽

Cited By ~ 8

Author(s):

Kamyar Kalantar-Zadeh ◽

Vidhya Parameswaran ◽

Linda H. Ficociello ◽

Ludmila Anderson ◽

Norma J. Ofsthun ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Routine Care ◽

Serum Phosphorus ◽

Pill Burden ◽

Dialysis Patients ◽

Database Analysis ◽

Baseline Serum ◽

The Mean ◽

Phosphorus Levels

Background: A database analysis was conducted to assess the effectiveness of sucroferric oxyhydroxide (SO) on lowering serum phosphorus and phosphate binder (PB) pill burden among adult peritoneal dialysis (PD) patients prescribed SO as part of routine care. Methods: Adult PD patients (n = 258) prescribed SO through a renal pharmacy service were analyzed. Baseline was 3 months before SO prescription. SO-treated follow-up was for 6 months or until either a new PB was prescribed, SO was not refilled, PD modality changed, or patient was discharged. In-range serum phosphorus was defined as ≤5.5 mg/dL. Results: At baseline, mean serum phosphorus was 6.59 mg/dL with 10 prescribed PB pills/day. The proportion of patients achieving in-range serum phosphorus increased by 72% from baseline to month 6. Prescribed PB pills/day decreased by 57% (10 at baseline to 4.3 at SO follow-up, p < 0.0001). The mean length of SO follow-up was 5.1 months; SO follow-up ended for 38, 27, and 50 patients at months 4, 5, and 6, respectively, due to no further PB fills, and for 10, 11, and 4 patients at months 4, 5, and 6, respectively, due to another PB prescribed. In patients with baseline serum phosphorus >5.5 mg/dL who achieved in-range serum phosphorus during SO follow-up for ≥1 quarter, a notable improvement in serum phosphorus (6.54 to 5.10 mg/dL, p < 0.0001) was observed, and there was a 53% reduction in PB pill burden (9.9 to 4.7, p < 0.0001). Conclusion: Among PD patients prescribed SO as part of routine care, improvements in serum phosphorus control and >50% reduction in PB pills/day were observed.

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Cinacalcet HCl Treatment in Patients with Chronic Kidney Disease Stage 3-4

Clinical Medicine Therapeutics ◽

10.4137/cmt.s3211 ◽

2009 ◽

Vol 1 ◽

pp. CMT.S3211 ◽

Cited By ~ 1

Author(s):

Yoshihiro Tominaga

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Chronic Kidney Disease Stage ◽

Serum Phosphorus ◽

Disease Stage ◽

Phosphorus Level ◽

Serum Phosphorus Level ◽

Ckd Stage ◽

Problematic Issue ◽

Phosphorus Levels

It has been clarified in patients with CKD stage 3-4, cinacalcet can reduce PTH levels without severe adverse events, however calcium levels significantly decrease and phosphorus levels increase. Increase of serum phosphorus level by cinacalcet in patients with CKD stage 3-4 is a problematic issue. Undesirable decreases in serum calcium and increases in serum phosphorus caused by cinacalcet require further investigation. For patients with CKD stage 3-4 who suffer from severely advanced 2HPT which cannot be controlled by the usual medical treatment or PTx, cinacalcet can be a useful medication for managing 2HPT.

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Circulating phosphorus level and risk of prostate cancer: a Mendelian randomization study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqab342 ◽

2021 ◽

Author(s):

Linshuoshuo Lv ◽

Ding Ye ◽

Jie Chen ◽

Yu Qian ◽

Alan Nuo Fu ◽

...

Keyword(s):

Prostate Cancer ◽

Observational Studies ◽

Mendelian Randomization ◽

Meta Analysis ◽

Serum Phosphorus ◽

Phosphorus Level ◽

Dietary Phosphorus ◽

Dietary Phosphorus Intake ◽

Phosphorus Intake ◽

Phosphorus Levels

Abstract Background Recent observational studies have suggested that circulating phosphorus levels are positively associated with risk of prostate cancer. However, little is known about the causal direction of the association. Objective To explore the potential causal relationship between circulating phosphorus and risk of prostate cancer, we conducted a Mendelian randomization (MR) study. Design Summary statistics of prostate cancer were obtained from a meta-analysis of genome-wide association studies (GWAS) consisting of 79,148 cases and 61,106 controls. Single nucleotide polymorphisms (SNP) associated with serum phosphorus level were selected from a GWAS of 291,408 individuals from the UK Biobank. MR analysis was performed using the inverse-variance weighted (IVW) method, supplemented with simple-median, weighted-median, maximum likelihood-based, MR-Egger regression and MR-PRESSO test. We also performed a meta-analysis of observational studies to assess the associations of dietary phosphorus intake and serum phosphorus level with risk of prostate cancer. Results In the MR analysis, a total of 125 independent SNPs associated with serum phosphorus levels were used as instrumental variables. Genetically predicted serum phosphorus levels were associated with a 19% increased risk of prostate cancer (95% confidence interval (CI): 9%, 31%) per one SD increment of serum phosphorus by IVW (P = 1.82 × 10–4). Sensitivity analyses using alternative MR methods produced similar positive associations, and no evidence of pleiotropy was detected by MR-Egger regression (P = 0.422). For meta-analysis, eight studies for dietary phosphorus intake and four for serum phosphorus levels were included involving a total of 669,080 participants. Consistently, high dietary phosphorus intake and serum phosphorus levels were associated with an 8% (95% CI: 4%, 12%) and 7% (95% CI: 1%, 14%) increase in prostate cancer risk, respectively. Conclusions Our study suggested a potential causal relationship between circulating phosphorus and risk of prostate cancer. Further studies are warranted to elucidate the underlying mechanism of phosphorus in the development of prostate cancer.

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Abstract 13331: Impact of Longer Hemodialysis Vintage With Higher Serum Phosphorus Level on Clinical Outcomes in Patients With Chronic Limb-threatening Ischemia

Circulation ◽

10.1161/circ.142.suppl_3.13331 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Naoko Higashino ◽

Osamu Iida ◽

ASAI MITSUTOSHI ◽

Masaharu Masuda ◽

Shin Okamoto ◽

...

Keyword(s):

Wound Healing ◽

Clinical Outcomes ◽

Outcome Measure ◽

Serum Phosphorus ◽

Tissue Loss ◽

Phosphorus Level ◽

Serum Phosphorus Level ◽

Ischemic Tissue ◽

Stage 4 ◽

Phosphorus Levels

Background: Although hemodialysis vintage and serum phosphorus level adversely impact on outcomes in the field of general population on hemodialysis, it has not systematically studied whether these have similar prognostic impacts on clinical outcomes in population with chronic limb-threatening ischemia (CLTI). Methods: The current study retrospectively analyzed 374 hemodialysis patients with CLTI presenting ischemic tissue loss (age: 72.3±9.0 years, male: 73.3%, diabetes mellitus: 39.6%, Rutherford 5: 75.9%, 6: 24.1%, WIFI stage 4: 50.0%) primarily treated with endovascular therapy (EVT) between April 2007 and December 2016. Primary outcome measure was 1-year amputation-free survival (AFS), while secondary outcome measure was 1-year wound healing. Predictors for each outcome were evaluated by Cox proportional hazards model. Result: One-year rate of AFS and wound healing rate were 70.5±2.5%, and 57.1±3.0%, respectively. Multivariate analysis demonstrated that body mass index (hazard ratio [HR], 0.918; 95% confidence interval [CI], 0.859-0.981; p=0.012), non-ambulatory status (HR, 1.887; 95% CI, 1.222-2.913; p=0.004), lower serum albumin level (HR, 0.591; 95% CI, 0.414-0.844; p=0.004), WIfI stage 4 (HR, 1.782; 95% CI, 1.156-2.748; p=0.009) and longer vintages for hemodialysis with higher serum phosphorus levels (HR, 1.670; 95% CI, 1.099-2.537; p=0.016) were significantly associated with 1-year AFS (Figure), while WIfI stage 4 (HR, 0.713; 95% CI, 0.519-0.979; p=0.037) was associated and longer vintages for hemodialysis with higher serum phosphorus levels was close to significant association (HR, 0.684; 95% CI, 0.467-1.000; p=0.050) with 1-year wound healing. Conclusion: Longer hemodialysis vintage with higher serum phosphorus level would adversely affect clinical outcomes after EVT for hemodialysis patients with CLTI presenting ischemic tissue loss.

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Efficacy and safety of calcium carbonate in normophosphataemic patients with chronic kidney disease Stages 3 and 4

Clinical Kidney Journal ◽

10.1093/ckj/sfz181 ◽

2019 ◽

Author(s):

Ricardo Neto ◽

João Frazão

Keyword(s):

Calcium Carbonate ◽

Vascular Calcification ◽

Mineral Metabolism ◽

Fractional Excretion ◽

Serum Phosphorus ◽

Phosphate Binders ◽

Control Group ◽

Dialysis Patients ◽

Fractional Excretion Of Phosphate ◽

Phosphorus Levels

Abstract Background Disordered bone and mineral metabolism are a common complication of chronic kidney disease (CKD). Phosphate binders are often prescribed in advanced CKD, when hyperphosphataemia develops. Little is known about the role of these drugs in earlier stages, when serum phosphorus levels are kept in the normal range by increased urinary excretion. Methods A retrospective, controlled observational study was conducted on a cohort of 78 pre-dialysis patients. Subjects had CKD Stage 3 or 4, normal serum phosphorus levels and increased urinary fractional excretion of phosphate. Thirty-eight patients receiving calcium carbonate for 24 months were compared with 40 patients under no phosphate binders, regarding mineral metabolism parameters and vascular calcification scores. Results Calcium carbonate decreased mean urinary fractional excretion of phosphate and median 24-h urine phosphorus, whereas no significant change was seen in the control group. Mean serum phosphorus and median serum intact parathyroid hormone (iPTH) remained stable in treated patients but increased in the control group. Vascular calcification, assessed by Kauppila and Adragão scores, worsened under calcium carbonate with no significant change in the control group. Conclusions Calcium carbonate reduced urinary phosphate excretion and prevented the rise in phosphorus and iPTH serum levels in a cohort of normophosphataemic pre-dialysis patients. However, treatment was associated with increased vascular calcification, suggesting that calcium-based phosphate binders are not a safe option for CKD patients.

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Comparative study of serum calcium and phosphorus level in pulmonary tuberculosis before and after chemotherapy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20171809 ◽

2017 ◽

Vol 5 (5) ◽

pp. 1874

Author(s):

Suman Godara ◽

Kiran Parihar ◽

Mamta Choudhary

Keyword(s):

Pulmonary Tuberculosis ◽

Serum Calcium ◽

Age Groups ◽

Acid Fast Bacillus ◽

The Body ◽

Serum Phosphorus ◽

Specific Work ◽

Phosphorus Level ◽

Calcium And Phosphorus ◽

Phosphorus Levels

Background: Pulmonary tuberculosis is a chronic granulomatous bacterial infection caused by an acid-fast bacillus, mycobacterium tuberculosis or tubercle bacillus. It is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs so it is called pulmonary tuberculosis. There are many minerals synthesized in the body in an appropriate amount for specific work. If any disease occurs in the body then mineral level imbalance, like wise in pulmonary tuberculosis calcium and phosphorus levels disturb. The changes in Calcium and Phosphorus level is considered as an important factor in pathophysiology of pulmonary tuberculosis patient.Methods: The proposed study was conducted in Department of Biochemistry with association of Department of TB and Chest of S.P. Medical College and attached Hospital, Bikaner. There were 40 cases and 40 controls in the age groups from 15 to 50 years. We took fresh samples and performed required tests following standard protocol. By Analytical grade chemicals and standard serum Calcium and Phosphorus were estimated using enzymatic kit method by auto analyzer.Results: The Mean±SD of serum calcium and serum phosphorus levels were found 8.688±0.7155 and 2.833±0.6443 before chemotherapy and 9.163±0.4661 and 3.695±0.3471 after chemotherapy.Conclusions: Persons, who developed pulmonary tuberculosis disease, had increased serum calcium and serum phosphorus level after chemotherapy compared to before chemotherapy patients.

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MO582LONGITUDINAL STUDY TO FIND THE ASSOCIATION OF SERUM PHOSPHORUS LEVEL WITH FGF 23 IN THREE DIFFERENT HYPERPHOSPHATEMIA MANAGEMENTS GROUPS OF STAGE 3 AND 4 CHRONIC KIDNEY DISEASE (CKD) PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab086.0020 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Navjot Kaur ◽

Himansu Mahapatra ◽

Neera Sharma ◽

Lalit Pursnani ◽

Muthukumar B ◽

...

Keyword(s):

Dietary Assessment ◽

Serum Phosphorus ◽

Phosphorus Level ◽

Treatment Groups ◽

Dietary Phosphorus ◽

2D Echocardiography ◽

Significant Difference ◽

One Year ◽

Fgf 23 ◽

Phosphorus Levels

Abstract Background and Aims There were paucity of clinical evidence on target serum phosphorus levelsin early CKD. Present longitudinal study finds target phosphorus level and its association with FGF 23 in three different hyperphosphatemia managements groups. Method This one year, prospective, randomised controlled, open labelled study was conducted among three equally allocated treatment groups in 120 screened early CKD patients.Group1 Dietary phosphorus modificationn40; Group2 calcium-based phosphate bindersn40 and Group3 non calcium-based phosphate bindersn40.Three monthly dietary assessment, MDRD e-GFR, phosphorus, calcium, iPTH, Alkaline phosphatise and six monthly FGF23, 2D Echocardiography, X ray of chest and abdomen were performed. Association of three categories of phosphorus level up to 3.9 mg/dl, 4 to 5mg/dl and >5mg/dl, rate of progression of all parameters and correlation with FGF 23among all three groups were studied. Results At baseline, all clinical and biochemical parameters were equally distributed with a controlled nutritional phosphate among all groups. There was no significant difference of FGF23 in all the three categories of phosphorus level among all groups. Association of serum phosphorus at the level of 5 mg/dl was there with iPTH and e-GFR at one year. Over one year there were significant decline in serum phosphorus levels in Group1 p 0.02, Group2 p 0.00,Group3p 0.05;FGF23 was declined significantly only in group3p 0.00.Correlation of FGF23 was positive and negative with iPTH r 0.19,p 0.03 and e-GFR r-0.30, p 0.00respectively but not with phosphorus p0.13 Conclusion Serum phosphorus levels up to 5mg/dl has no effect on FGF 23 at early CKD stages. Although different treatment groups have significant phosphorus reduction, non-calcium phosphate binder has major impact on FGF23 reduction.

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