title: Serum phosphate is an independent predictor of the total aortic calcification volume in non-hemodialysis patients undergoing cardiovascular surgery.
abstract: A high serum phosphate level is a well-known risk factor for vascular calcification (VC) in patients on hemodialysis (HD). However, the association between the serum phosphate level and VC in non-HD patients is unclear. Our aim was to assess the impact of serum phosphate level on aortic calcification (AC) volume in non-HD patients undergoing cardiovascular surgery.
  
  
  
  A total of 117 patients who underwent thoracoabdominal computed tomography as a preoperative general evaluation before cardiovascular surgery were enrolled. The total AC volume was quantified using the volume-rendering method by extracting the area ≥130HU within the entire aorta. The total AC volume index (AC-VI) was estimated as the total AC volume divided by the body surface area.
  
  
  
  In the 117 patients (64.7±13.1 years, 39% women), the median total AC-VI was 1.23mL/m(2). The mean estimated glomerular filtration rate (eGFR), adjusted serum calcium levels, and serum phosphate levels were 63.8±19.9mL/min/1.73m(2), 9.1±0.4mg/dL, and 3.6±0.6mg/dL, respectively. When the patients were classified into four quartiles based on their total AC-VI value, the serum phosphate level showed a positive correlation with a probability of being in the highest AC-VI quartile (R(2)=0.0146, p=0.0383) whereas the adjusted serum calcium level did not show a significant correlation (R(2)=0.0040, p=0.2615). A similar relationship between the serum phosphate level, adjusted serum calcium level, and AC-VI was confirmed when the total AC-VI was divided into the thoracic AC-VI and abdominal AC-VI. Multivariate analysis indicated that the serum phosphate level was an independent positive predictor of higher total AC-VI quartiles (β=0.8013, p=0.0160).
  
  
  
  An increase in serum phosphate level was associated with an increased AC burden in non-HD patients undergoing cardiovascular surgery.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Cardiology, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Kinugasa
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Shumpei
authors.initials: S
authors.lastname: Mori
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: toto54@hotmail.com.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Takaya
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ito
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Seimi
authors.initials: S
authors.lastname: Satomi-Kobayashi
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Sei
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishii
authors.affiliation: Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Atsushi K
authors.initials: AK
authors.lastname: Kono
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010710:Phosphates / Q000097:blood*; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers; D010710:Phosphates
keywords: Aortic calcification; Computed tomography; Non-hemodialysis patients; Serum phosphate; Vascular calcification