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Association of serum phosphorus with subclinical atherosclerosis in chronic kidney disease. Sex makes a difference

  • Marisa Martín
    Correspondence
    Corresponding authors.
    Affiliations
    Nephrology Service and Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Hospital Universitari Arnau de Vilanova, IRBLLEIDA. Av. Rovira Roure 80, 25198 Lleida, Spain
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  • Joan Valls
    Affiliations
    Biostatistics Unit, IRBLLEIDA. Av. Rovira Roure 80, 25198 Lleida, Spain
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  • Angels Betriu
    Affiliations
    Nephrology Service and Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Hospital Universitari Arnau de Vilanova, IRBLLEIDA. Av. Rovira Roure 80, 25198 Lleida, Spain
    Search for articles by this author
  • Author Footnotes
    1 JMV and EF share senior authorship.
    Elvira Fernández
    Footnotes
    1 JMV and EF share senior authorship.
    Affiliations
    Nephrology Service and Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Hospital Universitari Arnau de Vilanova, IRBLLEIDA. Av. Rovira Roure 80, 25198 Lleida, Spain
    Search for articles by this author
  • Author Footnotes
    1 JMV and EF share senior authorship.
    Jose M. Valdivielso
    Correspondence
    Corresponding authors.
    Footnotes
    1 JMV and EF share senior authorship.
    Affiliations
    Experimental Nephrology Laboratory, IRBLLEIDA. Av. Rovira Roure 80, 25198 Lleida, Spain
    Search for articles by this author
  • Author Footnotes
    1 JMV and EF share senior authorship.

      Highlights

      • Phosphate levels are associated with subclinical atheromatosis in CKD.
      • The effect of phosphate on subclinical atheromatosis is different according to sex.
      • In men, phosphate levels within the normal range associate with subclinical atheromatosis.

      Abstract

      Background

      Cardiovascular disease is the leading cause of mortality in chronic kidney disease (CKD). Serum phosphate has been associated to cardiovascular disease in the general population and this effect seems to be different according to sex. In the present study we analyze the effect of phosphate on subclinical atherosclerosis in the NEFRONA population and its effect depending on sex.

      Design

      Carotid ultrasound assessing the presence of plaques was performed by an itinerant team in 1687 CKD patients not in dialysis without previous cardiovascular events. Standard blood test and anthropometrical parameters were also recorded.

      Results

      Multivariate linear regression to model phosphate levels in patients with CKD showed an interaction of sex with age. Thus, among men, serum phosphate levels declined significantly with age almost linearly. Serum phosphate levels in women under the age of 40–45 years overlapped with those in men and then stayed above, showing and overall constant relationship. Multivariate logistic regression analysis showed that higher phosphate levels associated with a higher risk of presenting atheromatous plaque. This risk however was different according to sex. In men, phosphate levels within the normal range associated with an increased risk of subclinical atheromatosis whereas in women this risk only increased with serum levels over the normal range.

      Conclusions

      This study demonstrates that phosphate levels are associated with the presence of subclinical atheromatosis in a large CKD population. This effect of phosphate on subclinical atheromatosis was different according to sex, suggesting that a recommended serum phosphate levels could be different for male than for female CKD patients.

      Keywords

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      Linked Article

      • Importance of sex and gender in atherosclerosis and cardiovascular disease
        AtherosclerosisVol. 241Issue 1
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          In this special issue of the journal, there are papers on bone health and coronary artery calcification, age and sex differences in the effect of parental stroke on the progression of carotid intima-media thickness, macrophage subsets in the adipose tissue by sex and by reproductive age of women, uric acid levels and metabolic syndrome, sex differences in cardiovascular risk factors and disease prevention, severity of stable coronary artery disease and its biomarkers, cardiovascular disease and autoimmune diseases genetics of cardiovascular disease, outcome after CABG; association of serum phosphorus with subclinical atherosclerosis in chronic kidney disease and relationship of uric acid levels to coronary disease.
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