Chronic kidney disease (CKD) patients have high morbidity and mortality due to cardiovascu- lar disease including high prevalence of vascular calcifications. Serum phosphorus appears to be in- volved in pathophysiological mechanisms related to vascular calcification in CKD patients,1 which is a strong predictor of death in maintenance dial- ysis patients.2 When serum phosphorus levels are above 3.5 mg/dL, an increased in mortality risk is observed.3 Some, but not all, data suggest that switching from calcium-containing phosphorus binders to calcium-free binder therapy might mit- igate the progression of aortic calcification in hemodialysis patients.4 In the Dialysis Outcomes and Practice Pattern Study (DOPPS) Waves I (8,598 subjects), II (9,103 subjects), and III (8,327 subjects), serum phosphorus levels above 3.5 mg/dL were seen in over 90% of hemodialysis patients.5 Patients with phosphorus serum levels below 3.5 mg/dL are very few. At same time, DOPPS studies indicated high mortality for car- diovascular events in dialysis patients. A recent study indicated a significant correlation between serum phosphorus levels and the incidence of car- diovascular disease in the general population,6 making the hypothesis that serum phosphorus may be associated with subclinical atherosclerosis in the general population.7 Moreover, recent data from Foley et al.8 indicate that normal serum phosphorus levels, but in higher border range, may be a risk factor for coronary artery atheroscle- rosis in otherwise healthy young adults. DOPPS data suggest that in the United States and in the rest of DOPPS countries, there are still dialysis units in which physicians do not prescribe phos- phorus binders. If we see the same DOPPS re- ports, it is possible to show that at the same time E-mail: visavica@tin.it. Ó 2010 by the National Kidney Foundation, Inc. All rights reserved. 1051-2276/10/2002-0001$36.00/0 doi:10.1053/j.jrn.2009.10.004 there are patients with phosphorus serum levels as low than 3.5/mg/dL. We support the hypoth- esis that lowering phosphorus normal serums below 3.8 mg/dL could prevent cardiovascular calcifications. Moreover, the correlation between phosphorus levels and cardiovascular disease in the general community amplifies the problem for phosphatemia control. The eventual new target of serum phosphorus levels could be a major stim- ulus to have a more aggressive therapeutic strategy for hyperphosphatemia in dialysis patients and in the general community.

Is it time to modify the target range for serum phosphorus levels in chronic kidney disease (CKD)?

SAVICA, Vincenzo;BELLINGHIERI, Guido;SANTORO, Domenico
2010

Abstract

Chronic kidney disease (CKD) patients have high morbidity and mortality due to cardiovascu- lar disease including high prevalence of vascular calcifications. Serum phosphorus appears to be in- volved in pathophysiological mechanisms related to vascular calcification in CKD patients,1 which is a strong predictor of death in maintenance dial- ysis patients.2 When serum phosphorus levels are above 3.5 mg/dL, an increased in mortality risk is observed.3 Some, but not all, data suggest that switching from calcium-containing phosphorus binders to calcium-free binder therapy might mit- igate the progression of aortic calcification in hemodialysis patients.4 In the Dialysis Outcomes and Practice Pattern Study (DOPPS) Waves I (8,598 subjects), II (9,103 subjects), and III (8,327 subjects), serum phosphorus levels above 3.5 mg/dL were seen in over 90% of hemodialysis patients.5 Patients with phosphorus serum levels below 3.5 mg/dL are very few. At same time, DOPPS studies indicated high mortality for car- diovascular events in dialysis patients. A recent study indicated a significant correlation between serum phosphorus levels and the incidence of car- diovascular disease in the general population,6 making the hypothesis that serum phosphorus may be associated with subclinical atherosclerosis in the general population.7 Moreover, recent data from Foley et al.8 indicate that normal serum phosphorus levels, but in higher border range, may be a risk factor for coronary artery atheroscle- rosis in otherwise healthy young adults. DOPPS data suggest that in the United States and in the rest of DOPPS countries, there are still dialysis units in which physicians do not prescribe phos- phorus binders. If we see the same DOPPS re- ports, it is possible to show that at the same time E-mail: visavica@tin.it. Ó 2010 by the National Kidney Foundation, Inc. All rights reserved. 1051-2276/10/2002-0001$36.00/0 doi:10.1053/j.jrn.2009.10.004 there are patients with phosphorus serum levels as low than 3.5/mg/dL. We support the hypoth- esis that lowering phosphorus normal serums below 3.8 mg/dL could prevent cardiovascular calcifications. Moreover, the correlation between phosphorus levels and cardiovascular disease in the general community amplifies the problem for phosphatemia control. The eventual new target of serum phosphorus levels could be a major stim- ulus to have a more aggressive therapeutic strategy for hyperphosphatemia in dialysis patients and in the general community.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11570/1903093
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