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Abstract: TH-PO155

Target Serum Phosphate and Calcium Levels in Patients With CKD Undergoing Hemodialysis Receiving Prescriptions for Phosphate Binders: A Post Hoc Analysis of the LANDMARK Study

Session Information

  • CKD-MBD: Targets and Outcomes
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Yoshida, Kiryu, Showa Daigaku, Shinagawa, Tokyo, Japan
  • Mizukami, Takuya, Showa Daigaku, Shinagawa, Tokyo, Japan
  • Fukagawa, Masafumi, Tokai Daigaku, Isehara, Kanagawa, Japan
  • Akizawa, Tadao, Showa Daigaku, Shinagawa, Tokyo, Japan
  • Morohoshi, Hokuto, Showa Daigaku, Shinagawa, Tokyo, Japan
  • Sambe, Takehiko, Showa Daigaku, Shinagawa, Tokyo, Japan
  • Ogata, Hiroaki, Showa Daigaku Yokohama-shi Hokubu Byoin, Yokohama, Kanagawa, Japan
  • Uchida, Naoki, Showa Daigaku, Shinagawa, Tokyo, Japan

In contemporary CKD-MBD management, there is a need to reexamine optimal target values for phosphate (P) and calcium (Ca) to reduce cardiovascular event risk in patients on hemodialysis.


We performed a post-hoc analysis of the LANDMARK study. The outcomes were defined as cardiovascular events and all-cause death. 2135 patients on hemodialysis at risk for vascular calcification were analyzed using the time-dependent Cox proportional hazards model.


In stratified analysis, there was no difference in cardiovascular events between the lower half of the target range (3.5 - 4.8 mg/dL) and the higher half (4.8 - 6.0 mg/dL) for P (adjusted HR 1.18 (95% CI 0.86 - 1.63; p = 0.309)). For corrected Ca, the risk was higher in the higher half of the target range (9.2 - 10.0 mg/dL) than in the lower half (8.4 - 9.2 mg/dL) (adjusted HR 1.84 (95%CI 1.38 - 2.45; p < 0.001)). There was no difference in all-cause mortality between the lower half and the higher half of the target range for P or corrected Ca.


Stricter management of P alone was not associated with cardiovascular events in patients on hemodialysis. On the other hand, stricter management of Ca may reduce cardiovascular risk.

Results of Time-Dependent Cox Proportional Hazards Model
OutcomeVariablesNumber of
observation points
Hazard Ratio
(95% Confidence Interval)
P value
Cardiovascular eventsPhosphate (mg/dL)   
 3.5 - 4.829201.00 (reference) 
 4.8 - 6.037161.18 (0.86 - 1.63)0.309
 Corrected Calcium (mg/dL)   
 8.4 - 9.242631.00 (reference) 
 9.2 - 10.036551.84 (1.38 - 2.45)<0.001
All-cause mortalityPhosphate (mg/dL)   
 3.5 - 4.829441.00 (reference) 
 4.8 - 6.038190.94 (0.70 - 1.27)0.709
 Corrected Calcium (mg/dL)   
 8.4 - 9.243791.00 (reference) 
 9.2 - 10.037711.24 (0.94 - 1.63)0.133