title: Hyperphosphatemia as an independent risk factor for coronary artery calcification progression in peritoneal dialysis patients.
abstract: BACKGROUND
  Coronary artery calcification (CAC) is associated with cardiovascular mortality in end-stage renal disease (ESRD) patients. The present study aimed to identify modifiable risk factors for CAC progression in peritoneal dialysis (PD) patients.
  
  
  METHODS
  Adult patients who received regular PD for more than 6 months and underwent a series of coronary artery calcification score (CaCS) measurements by multislice spiral computed tomography (MSCT) with an interval of ≥ 6 months were included in this observational cohort study. The demographic characteristics and clinical data, including laboratory data and adequacy of PD, were collected. Curve estimation was used to fit the straight line and obtain the slope. Binary logistic regression was performed to identify the independent risk factors for CAC progression in the PD patients, and multivariate linear regression was conducted to identify factors associated with hyperphosphatemia.
  
  
  RESULTS
  A total of 207 adult patients on PD (116 men, 56.0 %) with a mean age of 59.8 ± 15.9 years were recruited to this study, and 157 of them (75.8 %) received three or more CaCS assessments. The patients were divided into a slow group (n = 137) and a rapid group (n = 70) according to the linear regression slope or the average speed of development. The follow-up time was 33.0 ± 18.8 months. Multivariate logistic regression revealed that age and serum phosphate level were independent risk factors for CAC progression after adjustments. Multivariate linear regression revealed that hyperphosphatemia was associated with elevations in the transferrin and serum albumin levels and normalized protein catabolic rate (nPCR) and reductions in the hemoglobin level, residual Ccr, and PD Ccr.
  
  
  CONCLUSIONS
  Hyperphosphatemia is an independent risk factor for CAC progression, and the serum phosphate level may be associated with protein intake and PD adequacy. These results provide important information for the clinical management of ESRD patients.
authors.affiliation: Division of Nephrology, Huashan Hospital, Fudan University, 12 Wulumuqi Road (middle), Shanghai, 200040, China. sdshangda@163.com.
authors.forename: Da
authors.initials: D
authors.lastname: Shang
authors.affiliation: Division of Nephrology, Huashan Hospital, Fudan University, 12 Wulumuqi Road (middle), Shanghai, 200040, China. qionghongxie@fudan.edu.cn.
authors.forename: Qionghong
authors.initials: Q
authors.lastname: Xie
authors.affiliation: Division of Nephrology, Huashan Hospital, Fudan University, 12 Wulumuqi Road (middle), Shanghai, 200040, China. ge_xiaoling@hotmail.com.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Ge
authors.affiliation: Division of Nephrology, Huashan Hospital Baoshan Branch, Fudan University, Shanghai, 200443, China. flynowhere@126.com.
authors.forename: Huanqing
authors.initials: H
authors.lastname: Yan
authors.affiliation: Division of Nephrology, Huashan Hospital, Fudan University, 12 Wulumuqi Road (middle), Shanghai, 200040, China. jingtianhuashan@163.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Tian
authors.affiliation: Division of Nephrology, Huashan Hospital, Fudan University, 12 Wulumuqi Road (middle), Shanghai, 200040, China. dingweikuang@medmail.com.cn.
authors.forename: Dingwei
authors.initials: D
authors.lastname: Kuang
authors.affiliation: Division of Nephrology, Huashan Hospital, Fudan University, 12 Wulumuqi Road (middle), Shanghai, 200040, China. chuanminghao@fudan.edu.cn.
authors.forename: Chuan-Ming
authors.initials: CM
authors.lastname: Hao
authors.affiliation: Division of Nephrology, Huashan Hospital, Fudan University, 12 Wulumuqi Road (middle), Shanghai, 200040, China. zhuty25@medmail.com.cn.|Division of Nephrology, Huashan Hospital Baoshan Branch, Fudan University, Shanghai, 200443, China. zhuty25@medmail.com.cn.
authors.forename: Tongying
authors.initials: T
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010710:Phosphates / Q000097:blood; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D036542:Tomography, Spiral Computed; D014168:Transferrin / Q000378:metabolism
chemical_list: D006454:Hemoglobins; D010710:Phosphates; D012709:Serum Albumin; D014168:Transferrin; D003404:Creatinine