Abstract: PO0594
Phosphate Indices and Atherosclerotic Cardiovascular Disease in CKD Patients: The CRIC Study
Session Information
- Vascular Disease, Nephrolithiasis, and Mineral Metabolism: Clinical
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Chen, Jing, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Wolf, Myles, Duke University, Durham, North Carolina, United States
- Isakova, Tamara, Northwestern University, Evanston, Illinois, United States
- He, Hua, Tulane University, New Orleans, Louisiana, United States
- Geng, Siyi, Tulane University, New Orleans, Louisiana, United States
- Rosas, Sylvia E., Joslin Diabetes Center, Boston, Massachusetts, United States
- Lora, Claudia M., University of Illinois at Chicago, Chicago, Illinois, United States
- Jaar, Bernard G., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Go, Alan S., Kaiser Permanente, Oakland, California, United States
- He, Jiang, Tulane University, New Orleans, Louisiana, United States
Background
Phosphate (Pi) overload may induce vascular calcification and inflammation. We studied prospective association of Pi indices with ASCVD events in the Chronic Renal Insufficiency Cohort (CRIC) Study.
Methods
3939 CKD patients without cirrhosis were enrolled. 3096 were included in the analysis after excluding those with missing variables. ASCVD was defined as the first stroke, MI, or PAD. A new Pi burden index was calculated as [(urine Pi/Cr ratio) × serum Pi (sPi)× alkaline phosphatase (ALP)] to reflect the effect of high Pi diet on kidneys, cellular space, and bones. ALP was correlated with sPi and PTH. Cox proportional hazards models were used to study associations of Pi indices with ASCVD, adjusting for ACC/AHA ASCVD and other established risk factors.
Results
Over a mean of 9 years, 699 had ASCVD events. Pi burden index was correlated with 24-hr urine Pi. FGF23 and Pi burden index increased in early CKD. There were exposure-response associations of sPi, FGF23 and Pi burden index with ASCVD (Table). PTH, FEPi, and 24-hr urine Pi were not associated with ASCVD.
Conclusion
Pi burden is associated with ASCVD. FGF23 and Pi burden index increased in early CKD. They may be used for ASCVD risk classification and for monitoring phosphate overload. Future studies are warranted.
Multivariable-adjusted Hazard Ratios of ASCVD Events Associated with Phosphate Indices
| HR (95% CI) | |
| Quartiles of Serum Pi, mg/dL | |
| ≤3.3 | 1.00 |
| 3.4 to 3.7 | 1.01 (0.81-1.27) |
| 3.8 to 4.1 | 1.22 (0.97-1.54) |
| >4.1 | 1.28 (1.01-1.62) |
| P-value for linear trend | 0.02 |
| Quartiles of FGF23, RU/mL | |
| ≤100 | 1.00 |
| 101 to 151 | 1.11 (0.88-1.40) |
| 152 to 245 | 1.26 (0.99-1.60) |
| >245 | 1.54 (1.19-1.99) |
| P-value for linear trend | 0.001 |
| Quartiles of Pi burden index | |
| ≤123 | 1.00 |
| 124 to 177 | 1.23 (0.98-1.54) |
| 178 to 262 | 1.38 (1.10-1.74) |
| >262 | 1.59 (1.26-2.01) |
| P-value for linear trend | <0.0001 |
Funding
- NIDDK Support