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Serum phosphate is associated with left ventricular mass in patients with chronic kidney disease: a cardiac magnetic resonance study
  1. Colin D Chue1,2,
  2. Nicola C Edwards1,2,
  3. William E Moody1,2,
  4. Richard P Steeds1,2,
  5. Jonathan N Townend1,2,
  6. Charles J Ferro1,2
  1. 1Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2Department of Renal Medicine, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Charles J Ferro, Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK; charles.ferro{at}uhb.nhs.uk

Abstract

Objective To explore the relationship between serum phosphate, arterial stiffness and left ventricular mass (LVM) in patients with early-stage chronic kidney disease (CKD).

Design A cross-sectional observational study.

Setting Single centre.

Patients 208 patients with stage 2 to stage 4 non-diabetic CKD.

Interventions Arterial stiffness was determined through measurement of aortic pulse wave velocity (PWV). Cardiac magnetic resonance was used to determine LVM.

Main outcome measure Relationship between serum phosphate, aortic PWV and LVM.

Results Mean age was 54±13 years, mean glomerular filtration rate was 50±15 ml/min/1.73 m2, mean serum phosphate was 1.11±0.21 mmol/l and mean PWV was 8.6±2.1 m/s. When the cohort was divided into quartiles according to serum phosphate, LVM increased across quartiles (p=0.04), with no significant differences in age, kidney function, blood pressure or PWV. Serum phosphate correlated with LVM (r=0.173; p=0.01), but PWV did not (p=0.2). In a regression model containing gender, serum phosphate, office systolic blood pressure, albumin/creatinine ratio and haemoglobin, 30% of the variation in LVM was explained (p<0.0005), with serum phosphate accounting for 5% of the variance.

Conclusion Serum phosphate is independently associated with LVM in patients with CKD. Interventional studies are required to determine whether this association is causative and whether reducing phosphate exposure reduces LVM in this population.

  • Aortic stiffness
  • cardiac MRI
  • cardiovascular risk
  • left ventricular mass
  • phosphate
  • acute coronary syndrome
  • aortic disease
  • transthoracic
  • MRI
  • ventricular hypertrophy
  • cardiomyopathy
  • renal diseases
  • cardiovascular disease
  • ventricular function
  • arterial wall morphology
  • echocardiography
  • risk factors
  • EBM
  • endothelium
  • imaging and diagnostics
  • atrial fibrillation
  • pulmonary valve disease
  • depression
  • tricuspid valve disease
  • valve disease
  • aortic valve disease
  • nuclear cardiology
  • tissue Doppler
  • echocardiography (transoesophageal)
  • acute myocardial infarction
  • autonomic regulation
  • heart failure
  • haemodynamics
  • pharmacokinetics/pharmacodynamics
  • endothelium
  • renin–angiotensin system

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Footnotes

  • Funding This study was supported by a grant from the British Heart Foundation and by an unrestricted educational grant from Genzyme Corporation.

  • Competing interests CJF has received lecture and advisory board fees from Genzyme Corporation. All authors are recipients of an unrestricted educational grant from Genzyme Corporation.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the West Midlands Research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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