Product of serum calcium and phosphorus (Ca × PO4) as predictor of cardiovascular disease risk in predialysis patients.
OBJECTIVE
The mortality rate of chronic kidney disease (CKD) patients is very high due to cardiovascular diseases (CVD) which cannot be fully justified by traditional CVD markers. Since, mineral bone disorder is common in CKD, product of serum calcium and phosphorus (Ca × PO4) can be a predictor of future CVD. So, our study aims to assess the utility of higher Ca × PO4 in prediction of CVD risk in predialysis CKD patients.


METHODS
150 CKD patients defined by NKF-KDOQI guideline not undergoing dialysis were recruited. Anthropometric and electrocardiographic parameters were recorded. We evaluated CVD risk by: i) Biochemical CVD markers, ii) NCEP ATP III guideline postulated risk factors and iii) Framingham risk scores.


RESULTS
Higher Ca × PO4 is associated with presence of Left Ventricular Hypertrophy, oxidative stress, microinflammation, hyperhomocysteinemia, hypercholesterolemia, hypertriglyceridemia and increased LDLc. Compared to cases with Ca × PO4 <55 mg2/dL2, cases with ≥55 mg2/dL2 had relative risk (RR) of 1.82 (95% CI 1.25-2.64) for CVD, 3.24 (95% CI 2.37-4.41) for stroke and 2.43 (95% CI 1.37-4.31) for coronary heart disease (CHD). Moreover, compared to lowest quartile of Ca x PO4, the highest quartile group had RR of 2.13 (95% CI 1.06-4.28) for CVD, 2.61(95% CI 1.80-3.75) for stroke and 2.84 (95% CI 1.15-7.0) for CHD.


CONCLUSIONS
In predialysis patients, higher Ca × PO4 is independent predictor of CVD risk.
Department of Clinical Biochemistry, Nepal Medical College, Kathmandu, Nepal. Electronic address: clinbio.prashant@gmail.com.
Prashant
P
Regmi
Charite- Universitä tsmedizin Berlin, Germany. Electronic address: i_bimala@yahoo.com.
Bimala
B
Malla
Charles Sturt University, NSW, Australia. Electronic address: clbioprajwal@gmail.com.
Prajwal
P
Gyawali
Department of Clinical Biochemistry, Manipal College of Medical Sciences, Pokhara, Nepal. Electronic address: manoj.sigdel@hotmail.com.
Manoj
M
Sigdel
Hokkaido University, Japan. Electronic address: cl.biochem@gmail.com.
Rojeet
R
Shrestha
Department of Medicine, TU Teaching Hospital, Kathmandu, Nepal. Electronic address: dibyasingh@hotmail.com.
Dibya Singh
DS
Shah
Department of Clinical Biochemistry, Nepal Medical College, Kathmandu, Nepal. Electronic address: Khanalm65@gmail.com.
Madhav Prasad
MP
Khanal
D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood*; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood*; D006435:Renal Dialysis; D012307:Risk Factors
D010758:Phosphorus; D002118:Calcium
Calcium × phosphorus; Cardiovascular risk; Chronic kidney disease; Predialysis