title: Serum phosphorus level is related to degree of clinical response to up-titration of heart failure pharmacotherapy.
abstract: Serum phosphorus abnormalities may pose a risk on the cardiovascular system. In heart failure (HF) phosphorus homeostatic mechanisms are altered and may be modified by modern HF therapy. The impact of therapy optimization on phosphorus abnormalities and related outcome remains unknown. In 722 patients with HF subjected to treatment up-titration we analyzed the prevalence of serum phosphorus abnormalities and their relation to HF severity on top of optimal treatment, and we assessed adjusted risk of phosphorus abnormalities at different stages of HF. We analyzed predictors of hypo- and hyperphosphatemia and relation to prognosis. Hypophosphatemia was associated with better response to therapy, was more prevalent in milder HF, and the association was independent of age, sex, BMI, etiology of HF, kidney function and the use of diuretics. Hypophosphatemic patients lost more phosphorus into urine. They had also less catabolic profile. Patients with hyperphosphatemia on top of optimal therapy responded worse to treatment. Hyperphosphatemia was more prevalent in advanced HF, but the effect was attenuated after adjustment for potential confounders. Clinical and biochemical profiles of hyperphosphatemics suggested domination of catabolism. Neither hypophosphatemia nor hyperphosphatemia modifies the outcome Serum phosphorus abnormalities are related to HF severity on top of optimal therapy. Hypophosphatemia occurring on HF up-titration therapy likely has a multifactorial pathophysiology comprising of urinary phosphorus wasting and refeeding effects. Hyperphosphatemia is linked to the catabolic profile but the effect of renal impairment can't be ruled out. The prognostic impact of serum phosphorus abnormalities remain to be established.
authors.affiliation: Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland. Electronic address: p.rozentryt@sccs.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Rozentryt
authors.affiliation: Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Nowak
authors.affiliation: Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Niedziela
authors.affiliation: Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Hudzik
authors.affiliation: Centre for Stroke Research Berlin, Charité Medical School, Berlin, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
authors.affiliation: Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Ewa A
authors.initials: EA
authors.lastname: Jankowska
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany; Department of Clinical Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, London, UK.
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
authors.affiliation: Clinical Division of Anesthesiology and Intensive Therapy of the Department of Anesthesiology, Intensive Treatment and Emergency Medicine, Medical University of Silesia, Zabrze, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Partyka
authors.affiliation: Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Edyta
authors.initials: E
authors.lastname: Kawecka
authors.affiliation: Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Myrda
authors.affiliation: Department of Heart Failure and Transplantology, Institute of Cardiology, Warszawa, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rywik
authors.affiliation: Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Bożena
authors.initials: B
authors.lastname: Szyguła
authors.affiliation: Clinical Division of Anesthesiology and Intensive Therapy of the Department of Anesthesiology, Intensive Treatment and Emergency Medicine, Medical University of Silesia, Zabrze, Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Kokocińska
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany; Department of Clinical Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, London, UK.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.affiliation: Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006706:Homeostasis; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D002317:Cardiovascular Agents; D010758:Phosphorus
keywords: Chronic; Epidemiology; Heart failure; Heart failure severity; Serum phosphorus