Strict phosphate control may slow coronary artery calcification for patients on dialysis
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Compared with standard targets, lower serum phosphate levels led to smaller changes in coronary artery calcification scores, suggesting stricter phosphate control may delay calcification progression for patients on hemodialysis.
“In patients on maintenance dialysis, cardiovascular mortality risk is remarkably high, which can be partly explained by severe coronary artery calcification (CAC),” Yoshitaka Isaka, MD, PhD, of the department of nephrology at Osaka University Graduate School of Medicine in Japan, and colleagues wrote. “Hyperphosphatemia has been reported to be associated with the severity of CAC. However, the optimal phosphate range in patients on dialysis remains unknown.”
For the study, researchers sought to determine the impact of two phosphate target ranges on CAC progression, as well as to compare the effects of two noncalcium-based phosphate binders.
In total, 115 patients aged between 20 and 80 years were randomized to either the sucroferric oxyhydroxide group or the lanthanum carbonate group. Patients in each group were further assigned to strict phosphate control (target between 3.5 mg per dL and 4.5 mg per dL) or standard control (target between 5 mg per dL and 6 mg per dL).
After 12 months, researchers observed the change (both percent and absolute) in CAC score was significantly lower for patients with stricter phosphate control, regardless of which phosphate binder was used.
Specific findings regarding phosphate control showed serum phosphate levels in the strict group decreased to 4.68 mg/dL vs. 5.54 mg/dL for the standard group and the decrease in serum phosphate levels was significantly higher in the strict group (1 mg/dL vs. 0.37 mg/dL).
“Although the KDIGO guidelines recommend lowering elevated phosphate levels toward the normal range in patients with CKD, including patients on dialysis, there have been no randomized trial data providing the evidence that lowering serum phosphate levels could improve any outcomes,” Isaka and colleagues concluded. “We were the first to demonstrate that decreasing serum phosphate levels toward the normal range in patients on dialysis could attenuate the exacerbation of CAC, an important predictor of all-cause mortality in patients on dialysis. This study suggests that interventions designed to decrease phosphate levels toward the normal range could lead to improved patient outcomes by slowing or reversing the progression of CAC.”
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