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Abstract: PO0594

Phosphate Indices and Atherosclerotic Cardiovascular Disease in CKD Patients: The CRIC Study

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • 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

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.


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.


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.


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 
3.4 to 3.71.01 (0.81-1.27)
3.8 to 4.11.22 (0.97-1.54)
>4.11.28 (1.01-1.62)
P-value for linear trend0.02
Quartiles of FGF23, RU/mL 
101 to 1511.11 (0.88-1.40)
152 to 2451.26 (0.99-1.60)
>2451.54 (1.19-1.99)
P-value for linear trend0.001
Quartiles of Pi burden index 
124 to 1771.23 (0.98-1.54)
178 to 2621.38 (1.10-1.74)
>2621.59 (1.26-2.01)
P-value for linear trend<0.0001


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