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Associations of time-dependent changes in phosphorus levels with cardiovascular diseases in patients undergoing hemodialysis: results from the Japan Dialysis Active Vitamin D (J-DAVID) randomized clinical trial

BACKGROUND: While the risk of exceeding the standard range of phosphorus levels has been investigated, the impact of the degree of fluctuations has not been investigated. METHODS: Data were derived from the Japan Dialysis Active Vitamin D trial, a 4-year prospective, randomized study involving 976 p...

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Autores principales: Koshi-Ito, Eri, Inaguma, Daijo, Ishii, Haruka, Yuzawa, Yukio, Kabata, Daijiro, Shintani, Ayumi, Inaba, Masaaki, Emoto, Masanori, Mori, Katsuhito, Morioka, Tomoaki, Nakatani, Shinya, Shoji, Tetsuo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664581/
https://www.ncbi.nlm.nih.gov/pubmed/36381378
http://dx.doi.org/10.1093/ckj/sfac172
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author Koshi-Ito, Eri
Inaguma, Daijo
Ishii, Haruka
Yuzawa, Yukio
Kabata, Daijiro
Shintani, Ayumi
Inaba, Masaaki
Emoto, Masanori
Mori, Katsuhito
Morioka, Tomoaki
Nakatani, Shinya
Shoji, Tetsuo
author_facet Koshi-Ito, Eri
Inaguma, Daijo
Ishii, Haruka
Yuzawa, Yukio
Kabata, Daijiro
Shintani, Ayumi
Inaba, Masaaki
Emoto, Masanori
Mori, Katsuhito
Morioka, Tomoaki
Nakatani, Shinya
Shoji, Tetsuo
author_sort Koshi-Ito, Eri
collection PubMed
description BACKGROUND: While the risk of exceeding the standard range of phosphorus levels has been investigated, the impact of the degree of fluctuations has not been investigated. METHODS: Data were derived from the Japan Dialysis Active Vitamin D trial, a 4-year prospective, randomized study involving 976 patients without secondary hyperparathyroidism undergoing hemodialysis in Japan. Laboratory data were collected every 6 months and the primary outcome was the time to the occurrence of cardiovascular events. The effect of time-dependent changes in phosphorus levels was assessed using a time-varying Cox proportional hazards regression model. RESULTS: The median serum phosphorus levels at baseline and at the final observation were 4.70 mg/dl [interquartile range (IQR) 3.90–5.30] and 5.00 mg/dl (IQR 4.20–5.80), respectively. Over each 6-month period, phosphorus changes ranged from −7.1 to +6.7 mg/dl, with a median value of −0.1 to +0.3 mg/dl. During follow-up, composite cardiovascular events occurred in 103 of 964 patients. Although the P-value for the interaction between serum phosphorus level fluctuations and baseline phosphorus levels was insignificant, the following trends were observed. First, patients with relatively high initial phosphorus levels over a 6-month period showed a trend towards a higher hazard, with greater changes in the phosphorus level over the 6-month period. Second, it was suggested that oral vitamin D receptor activators could contribute to the relationship between fluctuating phosphorus levels and cardiovascular events. CONCLUSIONS: Our results suggest the importance of maintaining stable phosphorus levels, not only in the normal range, but also without fluctuations, in the risk of cardiovascular events among patients without secondary hyperparathyroidism undergoing maintenance hemodialysis.
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spelling pubmed-96645812022-11-14 Associations of time-dependent changes in phosphorus levels with cardiovascular diseases in patients undergoing hemodialysis: results from the Japan Dialysis Active Vitamin D (J-DAVID) randomized clinical trial Koshi-Ito, Eri Inaguma, Daijo Ishii, Haruka Yuzawa, Yukio Kabata, Daijiro Shintani, Ayumi Inaba, Masaaki Emoto, Masanori Mori, Katsuhito Morioka, Tomoaki Nakatani, Shinya Shoji, Tetsuo Clin Kidney J Original Article BACKGROUND: While the risk of exceeding the standard range of phosphorus levels has been investigated, the impact of the degree of fluctuations has not been investigated. METHODS: Data were derived from the Japan Dialysis Active Vitamin D trial, a 4-year prospective, randomized study involving 976 patients without secondary hyperparathyroidism undergoing hemodialysis in Japan. Laboratory data were collected every 6 months and the primary outcome was the time to the occurrence of cardiovascular events. The effect of time-dependent changes in phosphorus levels was assessed using a time-varying Cox proportional hazards regression model. RESULTS: The median serum phosphorus levels at baseline and at the final observation were 4.70 mg/dl [interquartile range (IQR) 3.90–5.30] and 5.00 mg/dl (IQR 4.20–5.80), respectively. Over each 6-month period, phosphorus changes ranged from −7.1 to +6.7 mg/dl, with a median value of −0.1 to +0.3 mg/dl. During follow-up, composite cardiovascular events occurred in 103 of 964 patients. Although the P-value for the interaction between serum phosphorus level fluctuations and baseline phosphorus levels was insignificant, the following trends were observed. First, patients with relatively high initial phosphorus levels over a 6-month period showed a trend towards a higher hazard, with greater changes in the phosphorus level over the 6-month period. Second, it was suggested that oral vitamin D receptor activators could contribute to the relationship between fluctuating phosphorus levels and cardiovascular events. CONCLUSIONS: Our results suggest the importance of maintaining stable phosphorus levels, not only in the normal range, but also without fluctuations, in the risk of cardiovascular events among patients without secondary hyperparathyroidism undergoing maintenance hemodialysis. Oxford University Press 2022-08-03 /pmc/articles/PMC9664581/ /pubmed/36381378 http://dx.doi.org/10.1093/ckj/sfac172 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the ERA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Koshi-Ito, Eri
Inaguma, Daijo
Ishii, Haruka
Yuzawa, Yukio
Kabata, Daijiro
Shintani, Ayumi
Inaba, Masaaki
Emoto, Masanori
Mori, Katsuhito
Morioka, Tomoaki
Nakatani, Shinya
Shoji, Tetsuo
Associations of time-dependent changes in phosphorus levels with cardiovascular diseases in patients undergoing hemodialysis: results from the Japan Dialysis Active Vitamin D (J-DAVID) randomized clinical trial
title Associations of time-dependent changes in phosphorus levels with cardiovascular diseases in patients undergoing hemodialysis: results from the Japan Dialysis Active Vitamin D (J-DAVID) randomized clinical trial
title_full Associations of time-dependent changes in phosphorus levels with cardiovascular diseases in patients undergoing hemodialysis: results from the Japan Dialysis Active Vitamin D (J-DAVID) randomized clinical trial
title_fullStr Associations of time-dependent changes in phosphorus levels with cardiovascular diseases in patients undergoing hemodialysis: results from the Japan Dialysis Active Vitamin D (J-DAVID) randomized clinical trial
title_full_unstemmed Associations of time-dependent changes in phosphorus levels with cardiovascular diseases in patients undergoing hemodialysis: results from the Japan Dialysis Active Vitamin D (J-DAVID) randomized clinical trial
title_short Associations of time-dependent changes in phosphorus levels with cardiovascular diseases in patients undergoing hemodialysis: results from the Japan Dialysis Active Vitamin D (J-DAVID) randomized clinical trial
title_sort associations of time-dependent changes in phosphorus levels with cardiovascular diseases in patients undergoing hemodialysis: results from the japan dialysis active vitamin d (j-david) randomized clinical trial
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664581/
https://www.ncbi.nlm.nih.gov/pubmed/36381378
http://dx.doi.org/10.1093/ckj/sfac172
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