TY - JOUR
T1 - Phosphate Levels and Blood Pressure in Incident Hemodialysis Patients
T2 - A Longitudinal Study
AU - Huang, Cindy Xin
AU - Plantinga, Laura C.
AU - Fink, Nancy E.
AU - Melamed, Michal L.
AU - Coresh, Josef
AU - Powe, Neil R.
N1 - Funding Information:
Supported by grant no. RO1 DK 59616 from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, grant no. R01 HS 08365 from the Agency for Health Care Research and Quality, Rockville, Maryland, and grant no. R01 HL 62985 from the National Heart Lung and Blood Institute, Bethesda, MD. Dr. Powe is supported by grant K24 DK 02643 and Dr. Melamed is supported by grant K23-DK078774 from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.
PY - 2008/7
Y1 - 2008/7
N2 - An elevated serum phosphate level in hemodialysis patients has been associated with mineral deposition in blood vessels. We studied a possible physiologic consequence of hyperphosphatemia by examining the relation between serum phosphate levels and blood pressure in 707 incident hemodialysis patients from 75 clinics who were enrolled in a prospective cohort study. We conducted cross-sectional and longitudinal multiple linear regression analyses, adjusting for demographics, medical history, and laboratory factors. In cross-sectional analyses at baseline, elevated serum phosphate was associated with higher predialysis systolic blood pressure (SBP) and pulse pressure (PP) at the start of dialysis; each 1 mg/dL higher phosphate level was associated with 1.77 mm Hg higher SBP. In multivariable adjusted longitudinal analyses, for each 1 mg/dL higher serum phosphate at baseline, SBP was higher at 3 months, 1.36 mm Hg (P = .005); 6 months, 1.13 mm Hg (P = .035); 12 months, 1.65 mm Hg (P = .008); 18 months, 1.44 mm Hg (P = .031); and 27 months, 2.54 mm Hg (P = .002). PP was higher at 3 months, 0.80 mm Hg (P = .027); 6 months, 0.91 mm Hg (P = .022); 12 months, 1.45 mm Hg (P < .001); 18 months, 1.06 mm Hg (P = .026); and 27 months, 1.37 mm Hg (P = .020). This study suggests that serum phosphate level is strongly and independently associated with blood pressure in hemodialysis patients. The effect of rigorous control of serum phosphate levels on arterial stiffness and blood pressure should be studied in clinical trials.
AB - An elevated serum phosphate level in hemodialysis patients has been associated with mineral deposition in blood vessels. We studied a possible physiologic consequence of hyperphosphatemia by examining the relation between serum phosphate levels and blood pressure in 707 incident hemodialysis patients from 75 clinics who were enrolled in a prospective cohort study. We conducted cross-sectional and longitudinal multiple linear regression analyses, adjusting for demographics, medical history, and laboratory factors. In cross-sectional analyses at baseline, elevated serum phosphate was associated with higher predialysis systolic blood pressure (SBP) and pulse pressure (PP) at the start of dialysis; each 1 mg/dL higher phosphate level was associated with 1.77 mm Hg higher SBP. In multivariable adjusted longitudinal analyses, for each 1 mg/dL higher serum phosphate at baseline, SBP was higher at 3 months, 1.36 mm Hg (P = .005); 6 months, 1.13 mm Hg (P = .035); 12 months, 1.65 mm Hg (P = .008); 18 months, 1.44 mm Hg (P = .031); and 27 months, 2.54 mm Hg (P = .002). PP was higher at 3 months, 0.80 mm Hg (P = .027); 6 months, 0.91 mm Hg (P = .022); 12 months, 1.45 mm Hg (P < .001); 18 months, 1.06 mm Hg (P = .026); and 27 months, 1.37 mm Hg (P = .020). This study suggests that serum phosphate level is strongly and independently associated with blood pressure in hemodialysis patients. The effect of rigorous control of serum phosphate levels on arterial stiffness and blood pressure should be studied in clinical trials.
KW - Blood pressure
KW - Hemodialysis
KW - Phosphate
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U2 - 10.1053/j.ackd.2008.04.012
DO - 10.1053/j.ackd.2008.04.012
M3 - Article
C2 - 18565483
AN - SCOPUS:45149130993
SN - 1548-5595
VL - 15
SP - 321
EP - 331
JO - Advances in Chronic Kidney Disease
JF - Advances in Chronic Kidney Disease
IS - 3
ER -