ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO209

Effects of Consistently Strict Phosphate Control on Vascular and Valvular Calcification in Incident Hemodialysis Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Shimizu, Mao, Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
  • Fujii, Hideki, Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
  • Kono, Keiji, Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
  • Watanabe, Kentaro, Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
  • Sakamoto, Kazuo, Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
  • Goto, Shunsuke, Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
  • Nishi, Shinichi, Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
Background

Vascular calcification (VC) is a critical complication associated with cardiovascular disease in hemodialysis (HD) patients. The progression of VC is multifactorial, and serum phosphate control is particularly important. A recent randomized controlled trial (RCT) in maintenance HD patients showed that strict phosphate control slowed the progression of VC. Therefore, we investigated the effects of strict phosphate control on vascular and valvular calcification in incident HD patients.

Methods

This study was a post hoc analysis of our previous RCT regarding the effects of phosphate binders on VC in the incident hemodialysis (HD) patients. Computed tomography (CT) and ultrasoundcardiography (UCG) were performed at baseline and 18 months after initiation of HD, and we evaluated coronary artery calcium score (CACS) and cardiac valve calcification score (CVCS). Subsequently, the absolute changes in CACS (ΔCACS) and CVCS (ΔCVCS), and the percent change in CACS (%ΔCACS) and CVCS (%ΔCVCS) were calculated. Serum phosphate levels (serum P) were measured at 6, 12, and 18 months after initiation of HD, and phosphate control status was evaluated using the data as follows;(1) area under the curve (AUC) by multiplying the time spent with the extent to which serum P exceeded 4.5mg/dL, and (2) the number of times which serum P exceeded 4.5 mg/dL. The association of serum phosphate control with CACS and CVCS were investigated in this study.

Results

This study included 64 patients and they were divided into two groups depending on the median of AUC for serum P, both ΔCACS and %ΔCACS were significantly lower in the low AUC group (L-AUC) than in the high AUC group (H-AUC) (p <0.05). ΔCVCS and %ΔCVCS was also significantly lower in the L-AUC group than in the H-AUC group. Furthermore, ΔCACS and %ΔCACS were significantly lower, and ΔCVCS and %ΔCVCS tended to be lower in patients whose serum P were consistently below 4.5mg/dL than in those whose serum P were consistently over 4.5 mg/dl.

Conclusion

This study suggests that the consistently strict phosphate control could slow the progression of vascular and valvular calcification in incident HD patients.

Funding

  • Commercial Support