Cardiovascular risk with calcium and phosphorous levels in CKD

January 01, 0001

Cardiovascular risk with calcium and phosphorous levels in CKD

Clinical practice guidelines contain target levels for serum phosphorus, parathyroid hormone, and calcium in patients with chronic kidney disease. This international group of researchers performed a systematic review and meta-analysis looking at the effect of serum phosphorus, parathyroid hormone, and calcium levels and cardiovascular risk. They searched MEDLINE and EMBASE supplemented with searches of reference lists yielding 47 cohort studies (N = 327,644 patients) meeting inclusion criteria.

The researchers found: "The risk of death increased 18% for every 1- mg/dL increase in serum phosphorus (relative risk {RR}, 1.18). There was no significant association between all-cause mortality and serum level of parathyroid hormone (RR per 100-pg/mL increase, 1.01) or serum level of calcium (RR per 1-mg/dL increase, 1.08). Data for the association between serum level of phosphorus, parathyroid hormone, and calcium and cardiovascular death were each available in only 1 adequately adjusted cohort study. Lack of adjustment for confounding variables was not a major limitation of the available studies."

The researchers concluded: "The evidentiary basis for a strong, consistent, and independent association between serum levels of calcium and parathyroid hormone and the risk of death and cardiovascular events in chronic kidney disease is poor. There appears to be an association between higher serum levels of phosphorus and mortality in this population."

Calcium and parathyroid levels are not associated with cardiovascular risk in CKD patients, although phosphorous levels may correlate with mortality risk.

For the full abstract, click here.

JAMA 305(11):1119-1127, 16 March 2011
© 2011 American Medical Association
Serum Levels of Phosphorus, Parathyroid Hormone, and Calcium and Risks of Death and Cardiovascular Disease in Individuals With Chronic Kidney Disease. Suetonia C. Palmer, Andrew Hayen, Petra Macaskill, et al.

Category: K. Circulatory, U. Urinary System. Keywords: calcium, phosphorous, parathyroid hormone, serum, chronic kidney disease, systematic review with meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 29 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.