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Abstract: FR-PO168

Association of Serum Phosphate with Peripheral Artery Disease (PAD) in Hemodialysis Patients: Ten-Year Outcomes of the Q-Cohort Study

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Shimamoto, Sho, Kyushu University, Fukuoka, Japan
  • Yamada, Shunsuke, Kyushu University, Fukuoka, Japan
  • Hiyamuta, Hiroto, Kyushu University, Fukuoka, Japan
  • Taniguchi, Masatomo, Fukuoka Renal Clinic, Fukuoka, Japan
  • Tokumoto, Masanori, Department of Internal Medicine, Fukuoka Dental College, Sawara-ku, FUKUOKA, Japan
  • Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Japan
  • Nakano, Toshiaki, Kyushu University, Fukuoka, Japan
  • Kitazono, Takanari, Kyushu University, Fukuoka, Japan

Peripheral artery disease (PAD) is caused by arteriosclerosis and is one of the critical cardiovascular complications in hemodialysis patients. Although serum phosphate is a known risk factor for cardiovascular events, it is unclear whether serum phosphate is associated with PAD. The aim of the present study was to clarify the relationship between serum phosphate level and the risk for PAD in hemodialysis patients.


A total of 3,506 hemodialysis patients registered to the Q-cohort Study was followed up for 10-years. PAD was defined as intervention for PAD including endovascular therapy, revascularization, and amputation. Patients were divided into quartiles based on baseline serum phosphate level; Q1 (n=886), <4.2 mg/dL; Q2 (n=838), 4.2 to 4.8 mg/dL; Q3 (n=909), 4.9 to 5.6 mg/dL; Q4 (n=873), 5.7≤ mg/dL. Multivariable-adjusted Cox proportional hazards risk model was employed to examine the association between serum phosphate level and the risk for PAD.


During the follow-up period, 257 patients developed PAD. Cox proportional hazards risk model showed a significant association between baseline serum phosphate level and PAD: hazard ratio [HR] (95% confidence interval [CI]) per 1 mg/dL increase in serum phosphate level, 1.23 (1.09 -1.37). The risk for PAD in Q4 was significantly increased compared with that in Q1: HR (95% CI), 1.72 (1.19-2.50). When a multivariable-adjusted restricted cubic spline curve was depicted, the HR for PAD increased nonlinearly as the serum phosphate level increased. Furthermore, the effect of hyperphosphatemia on the risk for PAD was significantly enhanced in patients without diabetes, patients with history of cardiovascular events or patients with high serum C-reactive protein levels.


Elevated serum phosphate level was associated with an increased risk of intervention for PAD in hemodialysis patients.


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