Time to Shift our Mindset to a Phosphate-Centric Approach for Prevention of Cardiovascular Calcification in the Dialysis Population

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

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  • Clinical Implication of Consistently Strict Phosphate Control for Coronary and Valvular Calcification in Incident Patients Undergoing Hemodialysis

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<p> Aims: Serum phosphate control is crucial for the progression of vascular and valvular calcifications. Strict phosphate control is recently suggested; however, there is a lack of convincing evidence. Therefore, we explored the effects of strict phosphate control on vascular and valvular calcifications in incident patients undergoing hemodialysis.</p><p> Methods: A total of 64 patients undergoing hemodialysis from our previous randomized controlled trial were included in this study. Coronary artery calcification score (CACS) and cardiac valvular calcification score (CVCS) were evaluated using computed tomography and ultrasound cardiography at baseline and 18 months after the initiation of hemodialysis. The absolute changes in CACS (ΔCACS) and CVCS (ΔCVCS) and the percent change in CACS (%ΔCACS) and CVCS (%ΔCVCS) were calculated. Serum phosphate level was measured at 6, 12, and 18 months after the initiation of hemodialysis. Moreover, phosphate control status was evaluated using the area under the curve (AUC) by the amount of time spent with a serum phosphate level of ≥ 4.5 mg/dL and the extent to which this threshold exceeded over the observation period. </p><p>Results: ΔCACS, %ΔCACS, ΔCVCS, and %ΔCVCS were significantly lower in the low AUC group than in the high AUC group. ΔCACS and %ΔCACS were also significantly lower. ΔCVCS and %ΔCVCS tended to be lower in patients whose serum phosphate level never exceeded 4.5 mg/dL than in those whose serum phosphate level continuously exceeded 4.5 mg/dL. AUC significantly correlated with ΔCACS and ΔCVCS.</p><p> Conclusion: Consistently strict phosphate control may slow the progression of coronary and valvular calcifications in incident patients undergoing hemodialysis.</p>

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