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Abstract: TH-PO169

Phosphate Homeostasis and Apparent Treatment Resistant Hypertension in CKD: The CRIC 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

Authors

  • Chen, Jing, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Alper, Arnold B., Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Erol, Halil K., Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Geng, Siyi, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • He, Hua, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Sharshir, Moh'd, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Abubakar Ibrahim, Ismail, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Oygen, Suayp, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Bundy, Joshua David, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • He, Jiang, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
Background

Abnormal phosphate (Pi) homeostasis is associated with vascular dysfunction. We studied the associations of Pi indices with apparent treatment resistant hypertension (ATRH) in CKD.

Methods

The CRIC Study enrolled 3939 CKD patients. 3556 without missing data were included in this analysis. ATRH was defined as SBP ≥140 or DBP ≥90 mm Hg while taking ≥3 BP medications or BP <140/90 mm Hg while taking ≥4 medications. Novel Pi overload index was calculated as [serum Pi x (urine Pi/Cr ratio) x alkaline phosphatase (a marker reflecting bone turnover)] to synergistically reflect the effect of high Pi intake on serum Pi, kidneys, and bones. Logistic regression models were used to examine the associations of baseline Pi overload index, serum Pi, FGF23, and PTH with ATRH.

Results

The Pi indices are significantly associated with ATRH (Table). The associations remain similar after adjusting for FGF23.

Conclusion

These data suggest that Pi overload is independently associated with ATRH. Maintaining normal Pi homeostasis may improve BP control.

Multivariable-Adjusted Odds Ratios of ATRH (95% CI) Associated with Phosphate Indices
QuartileATRH
Phosphate Overload Index 
≤123Reference
>123 to 1771.03 (0.81, 1.31)
>177 to 2621.26 (0.99, 1.61)
>2621.63 (1.27, 2.10)
Serum Phosphate, mg/mL 
< 3.3Reference
3.3 to < 3.71.07 (0.83, 1.37)
3.7 to <4.21.11 (0.87, 1.41)
≥ 4.21.37 (1.06, 1.78)
FGF23, RU/ml 
< 95.8Reference
95.8 to < 145.51.07 (0.83, 1.38)
145.5 to < 239.21.33 (1.02, 1.73)
≥ 239.21.29 (0.97, 1.72)
Total Parathyroid Hormone, pg/mL 
< 35.0Reference
35.0 to < 54.01.28 (0.99, 1.66)
54.0 to < 89.61.47 (1.14, 1.88)
≥ 89.61.70 (1.30, 2.23)

Adjusted for age, sex, race, BMI, physical activity, drinking, 24-h urine sodium, eGFR, diuretics, NSAIDs, HbA1c, IL-6, TNF-α, and TGF-β.

Funding

  • NIDDK Support