title: Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community based cohort study.
abstract: BACKGROUND
  Serum phosphate is a known risk factor for cardiovascular events and mortality in people with chronic kidney disease (CKD), however data on the association of these outcomes with serum phosphate in the general population are scarce. We investigate this relationship in people with and without CKD in a large community-based population.
  
  
  METHODS
  Three groups from an adult cohort of the Quality Improvement in Chronic Kidney Disease (QICKD) cluster randomised trial (ISRCTN56023731) were followed over a period of 2.5 years: people with normal renal function (N = 24,184), people with CKD stages 1-2 (N = 20,356), and people with CKD stages 3-5 (N = 13,292). We used a multilevel logistic regression model to determine the association between serum phosphate, in these groups, and a composite outcome of all-cause mortality, cardiovascular events, and advanced coronary artery disease. We adjusted for known cardiovascular risk factors.
  
  
  RESULTS
  Higher phosphate levels were found to correlate with increased cardiovascular risk. In people with normal renal function and CKD stages 1-2, Phosphate levels between 1.25 and 1.50 mmol/l were associated with increased cardiovascular events; odds ratio (OR) 1.36 (95% CI 1.06-1.74; p = 0.016) in people with normal renal function and OR 1.40 (95% CI 1.09-1.81; p = 0.010) in people with CKD stages 1-2. Hypophosphatemia (<0.75 mmol/l) was associated with fewer cardiovascular events in people with normal renal function; OR 0.59 (95% CI 0.36-0.97; p = 0.049). In people with CKD stages 3-5, hyperphosphatemia (>1.50 mmol/l) was associated with increased cardiovascular risk; OR 2.34 (95% CI 1.64-3.32; p<0.001). Other phosphate ranges were not found to have a significant impact on cardiovascular events in people with CKD stages 3-5.
  
  
  CONCLUSIONS
  Serum phosphate is associated with cardiovascular events in people with and without CKD. Further research is required to determine the mechanisms underlying these associations.
authors.affiliation: Department of Health Care Management and Policy, University of Surrey, Guildford, United Kingdom.
authors.forename: Andrew Peter
authors.initials: AP
authors.lastname: McGovern
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.forename: Jeremy
authors.initials: J
authors.lastname: van Vlymen
authors.forename: Harshana
authors.initials: H
authors.lastname: Liyanage
authors.forename: Charles Richard
authors.initials: CR
authors.lastname: Tomson
authors.forename: Hugh
authors.initials: H
authors.lastname: Gallagher
authors.forename: Meena
authors.initials: M
authors.lastname: Rafiq
authors.forename: Simon
authors.initials: S
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications; D015331:Cohort Studies; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006706:Homeostasis; D006801:Humans; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010710:Phosphates / Q000097:blood*; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000175:diagnosis; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D010710:Phosphates
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