title: Higher serum phosphorus is associated with catabolic/anabolic imbalance in heart failure.
abstract: BACKGROUND
  A higher serum phosphate level is associated with worse outcome. Energy-demanding intracellular transport of phosphate is needed to secure anion bioavailability. In heart failure (HF), energy starvation may modify intracellular and serum levels of phosphate. We analysed determinants of serum phosphates in HF and assessed if catabolic/anabolic balance (CAB) was associated with elevation of serum phosphate.
  
  
  METHODS
  We retrospectively reviewed data from 1029 stable patients with HF and have calculated negative (loss) and positive (gain) components of weight change from the onset of HF till index date. The algebraic sum of these components was taken as CAB. The univariate and multivariable predictors of serum phosphorus were calculated. In quintiles of CAB, we have estimated odds ratios for serum phosphorus above levels previously identified to increase risk of mortality. As a reference, we have selected a CAB quintile with similar loss and gain.
  
  
  RESULTS
  Apart from sex, age, and kidney function, we identified serum sodium, N-terminal fragment of pro-brain-type natriuretic peptide, and CAB as independent predictors of serum phosphorus. The odds for serum phosphorus above thresholds found in literature to increase risk were highest in more catabolic patients. In most catabolic quintile relative to neutral balance, the odds across selected phosphorus thresholds rose, gradually peaking at 1.30 mmol/L with a value of 3.29 (95% confidence interval: 2.00-5.40, P < 0.0001) in an unadjusted analysis and 2.55 (95% confidence interval: 1.38-2.72, P = 0.002) in a fully adjusted model.
  
  
  CONCLUSIONS
  Metabolic status is an independent determinant of serum phosphorus in HF. Higher catabolism is associated with serum phosphorus above mortality risk-increasing thresholds.
authors.affiliation: Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia Zabrze, Poland.
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: Jacek T
authors.initials: JT
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: Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia Zabrze, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lekston
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: 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: Division of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG) Göttingen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
authors.affiliation: Clinical Division of Anaesthesiology 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: Department of Heart Failure and Transplantology, Institute of Cardiology Warsaw, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rywik
authors.affiliation: Division of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG) Göttingen, Germany.
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
keywords: Anabolism; Catabolism; Chronic; Determinants; Heart failure; Serum phosphorus