TY - JOUR
T1 - Association of hyperphosphatemia with an increased risk of sudden death in patients on hemodialysis
T2 - Ten-year outcomes of the Q-Cohort Study
AU - Hiyamuta, Hiroto
AU - Yamada, Shunsuke
AU - Taniguchi, Masatomo
AU - Tokumoto, Masanori
AU - Tsuruya, Kazuhiko
AU - Nakano, Toshiaki
AU - Kitazono, Takanari
N1 - Funding Information:
The Q-Cohort Study was supported by The Kidney Foundation, Japan ( JKFB07-13 , JKFB08-8 , and JKFB11-11 ) and The Japan Dialysis Outcome Research Foundation ( 076-02 ), without restriction on publications.
PY - 2021/1
Y1 - 2021/1
N2 - Background and aims: Sudden death is one of the most common causes of death among patients on hemodialysis. Although hyperphosphatemia is a well-known risk factor for cardiovascular and all-cause deaths, the studies focusing on the relationship between serum phosphate levels and the risk of sudden death are limited. This study aimed to clarify the relationship between serum phosphate levels and the risk of sudden death in patients on hemodialysis. Methods: This is a multicenter, longitudinal, and observational study. A total of 3505 patients, registered in the Q-Cohort Study, who underwent maintenance hemodialysis, and were followed up for 10 years, were included. Patients were divided into quartiles on the basis of baseline serum phosphate levels: Q1 (n = 886), <4.2 mg/dL; Q2 (n = 837), 4.2–4.8 mg/dL; Q3 (n = 908), 4.9–5.6 mg/dL; and Q4 (n = 874), ≥5.7 mg/dL. Associations between baseline serum phosphate levels and sudden death were analyzed using the Cox proportional hazards model and the Fine–Gray regression model. Results: During the follow-up period, 227 patients died from sudden death. The risk for sudden death was significantly higher in the highest quartile (Q4) than in the lowest quartile (Q1) as the reference group (multivariable-adjusted hazard ratios and 95% confidence intervals: Q1, 1.00; Q2, 1.15 [0.77–1.70], Q3, 1.31 [0.89–1.93], and Q4, 1.72 [1.14–2.59]; hazard ratio for every 1-mg/dL increase in the serum phosphate level, 1.23 [1.09–1.39]; p < 0.001). Conclusions: Hyperphosphatemia is independently associated with an elevated risk of sudden death in patients on hemodialysis.
AB - Background and aims: Sudden death is one of the most common causes of death among patients on hemodialysis. Although hyperphosphatemia is a well-known risk factor for cardiovascular and all-cause deaths, the studies focusing on the relationship between serum phosphate levels and the risk of sudden death are limited. This study aimed to clarify the relationship between serum phosphate levels and the risk of sudden death in patients on hemodialysis. Methods: This is a multicenter, longitudinal, and observational study. A total of 3505 patients, registered in the Q-Cohort Study, who underwent maintenance hemodialysis, and were followed up for 10 years, were included. Patients were divided into quartiles on the basis of baseline serum phosphate levels: Q1 (n = 886), <4.2 mg/dL; Q2 (n = 837), 4.2–4.8 mg/dL; Q3 (n = 908), 4.9–5.6 mg/dL; and Q4 (n = 874), ≥5.7 mg/dL. Associations between baseline serum phosphate levels and sudden death were analyzed using the Cox proportional hazards model and the Fine–Gray regression model. Results: During the follow-up period, 227 patients died from sudden death. The risk for sudden death was significantly higher in the highest quartile (Q4) than in the lowest quartile (Q1) as the reference group (multivariable-adjusted hazard ratios and 95% confidence intervals: Q1, 1.00; Q2, 1.15 [0.77–1.70], Q3, 1.31 [0.89–1.93], and Q4, 1.72 [1.14–2.59]; hazard ratio for every 1-mg/dL increase in the serum phosphate level, 1.23 [1.09–1.39]; p < 0.001). Conclusions: Hyperphosphatemia is independently associated with an elevated risk of sudden death in patients on hemodialysis.
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U2 - 10.1016/j.atherosclerosis.2020.11.020
DO - 10.1016/j.atherosclerosis.2020.11.020
M3 - Article
C2 - 33260008
AN - SCOPUS:85096858837
VL - 316
SP - 25
EP - 31
JO - Atherosclerosis
JF - Atherosclerosis
SN - 0021-9150
ER -