title: Serum Phosphate and Retinal Microvascular Changes: The Multi-Ethnic Study of Atherosclerosis and the Beaver Dam Eye Study.
abstract: Higher levels of serum phosphate are strongly linked to increased risk of cardiovascular disease and therapies aimed to lower serum phosphate are employed in the management of patients with chronic kidney disease (CKD). Data are limited, however, on serum phosphate as a risk factor for microvascular disease in community-based populations. It is important to determine the impact of novel risk factors, such as phosphate, on the microvasculature.
  
  
  
  We conducted a prospective study of 3919 individuals in the Multi-Ethnic Study of Atherosclerosis (MESA) and 3544 individuals in the Beaver Dam Eye Study (BDES) to test the associations of serum phosphate with retinopathy and retinal vessel caliber, and change in retinopathy severity and change in retinal vessel caliber.
  
  
  
  Mean (standard deviation) serum phosphate was 3.66 (0.52) mg/dl in the MESA and 3.77 (0.55) mg/dl in the BDES. In multivariable adjusted models, phosphate was significantly associated with prevalent retinopathy in the MESA (Odds Ratio [OR] per 1 mg/dl increase in phosphate, 1.22; Confidence Interval [CI] 1.02-1.47) and the BDES (OR 1.06; CI 1.01-1.11). In stratified analyses, these relationships were even stronger and only seen in individuals with diabetes in both the MESA (OR 1.81; CI 1.30-2.53) and the BDES (OR 1.16; CI 1.05-1.29). Phosphate was not associated with incident or change in retinopathy severity, nor any retinal caliber outcome.
  
  
  
  Among community-living individuals with low prevalence of CKD, higher serum phosphate was associated with prevalent retinopathy in individuals with diabetes. Further longitudinal assessments in patients with diabetes necessitate further investigation.
authors.affiliation: a Division of Nephrology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA.|b Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine , Chicago , IL , USA.|c Jesse Brown Veterans Administration Medical Center , Division of Nephrology , Chicago , IL , USA.
authors.forename: Rupal
authors.initials: R
authors.lastname: Mehta
authors.affiliation: b Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine , Chicago , IL , USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hodakowski
authors.affiliation: b Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine , Chicago , IL , USA.
authors.forename: Xuan
authors.initials: X
authors.lastname: Cai
authors.affiliation: d Ocular Epidemiology Research Group, University of Wisconsin-Madison , Madison , WI , USA.
authors.forename: Kris E
authors.initials: KE
authors.lastname: Lee
authors.affiliation: e Division of Nephrology , University of Washington , Seattle , WA , USA.
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Kestenbaum
authors.affiliation: e Division of Nephrology , University of Washington , Seattle , WA , USA.
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.affiliation: f Department of Ophthalmology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA.
authors.forename: Amani
authors.initials: A
authors.lastname: Fawzi
authors.affiliation: g Vitreo-Retinal Department , Singapore National Eye Centre , Singapore , Singapore.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: h Division of Nephrology , University of California San Diego School of Medicine , San Diego , CA , USA.
authors.forename: Joachim
authors.initials: J
authors.lastname: Ix
authors.affiliation: d Ocular Epidemiology Research Group, University of Wisconsin-Madison , Madison , WI , USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Klein
authors.affiliation: d Ocular Epidemiology Research Group, University of Wisconsin-Madison , Madison , WI , USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.affiliation: a Division of Nephrology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA.|b Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine , Chicago , IL , USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Isakova
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000097:blood* / Q000175:diagnosis / Q000208:ethnology; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D015995:Prevalence; D011446:Prospective Studies; D012164:Retinal Diseases / Q000097:blood* / Q000175:diagnosis / Q000208:ethnology; D012171:Retinal Vessels / Q000473:pathology* / Q000503:physiopathology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D010710:Phosphates
keywords: Diabetes; microvascular disease; phosphate; retinopathy