Phosphorus Is Associated with Coronary Artery Disease in Patients with Preserved Renal Function

High serum phosphorus levels have been associated with mortality and cardiovascular events in patients with chronic kidney disease and in the general population. In addition, high phosphorus levels have been shown to induce vascular calcification and endothelial dysfunction in vitro. The aim of this study was to evaluate the relation of phosphorus and coronary calcification and atherosclerosis in the setting of normal renal function. This was a cross-sectional study involving 290 patients with suspected coronary artery disease and undergoing elective coronary angiography, with a creatinine clearance >60 ml/min/1.73 m2. Coronary artery obstruction was assessed by the Friesinger score and coronary artery calcification by multislice computed tomography. Serum phosphorus was higher in patients with an Agatston score >10 than in those with an Agatston score ≤10 (3.63±0.55 versus 3.49±0.52 mg/dl; p = 0.02). In the patients with Friesinger scores >4, serum phosphorus was higher (3.6±0.5 versus 3.5±0.6 mg/dl, p = 0.04) and median intact fibroblast growth factor 23 was lower (40.3 pg/ml versus 45.7 pg/ml, p = 0.01). Each 0.1-mg/dl higher serum phosphate was associated with a 7.4% higher odds of having a Friesinger score >4 (p = 0.03) and a 6.1% greater risk of having an Agatston score >10 (p = 0.01). Fibroblast growth factor 23 was a negative predictor of Friesinger score (p = 0.002). In conclusion, phosphorus is positively associated with coronary artery calcification and obstruction in patients with suspected coronary artery disease and preserved renal function

Early postoperative parathormone sampling and prognosis after total parathyroidectomy in secondary hyperparathyroidism

Abstract Introduction: There is possibility of a supernumerary hyperplastic parathyroid gland in dialysis patients after total parathyroidectomy and autograft in dialysis patients. Objective: To test if the early postoperative measure of parathyroid hormone (PTH) can identify persistent hyperparathyroidism. Methods: A prospective cohort of dialysis patients submitted to parathyroidectomy had PTH measured up to one week after operation. The absolute value and the relative decrease were analyzed according to clinical outcome of satisfactory control of secondary hyperparathyroidism or persistence. Results: Of 51 cases, preoperative PTH varied from 425 to 6,964 pg/mL (median 2,103 pg/mL). Postoperatively, PTH was undetectable in 28 cases (54.9%). In eight individuals (15.7%) the PTH was lower than 16 pg/mL, in 10 (19.6%) the PTH values were between 16 and 87pg/mL, and in five (9.8%), PTH was higher than 87 pg/mL. Undetectable PTH was more common in patients with preoperative PTH below the median (p = 0.0002). There was a significant correlation between preoperative PTH and early postoperative PTH (Spearman R = 0.42, p = 0.002). A relative decrease superior to 95% was associated to satisfactory clinical outcome. A relative decrease less than 80% was associated to persistent disease, despite initial postoperative hypocalcemia. Conclusion: Measurement of PTH in the first days after parathyroidectomy in dialysis patients may suggest good clinical outcome if a decrease of at least 95% of the preoperative value is observed. Less than 80% PTH decrease is highly suggestive of residual hyperfunctioning parathyroid tissue with persistent hyperparathyroidism, and an early reintervention may be considered

Characteristics of the patients evaluated, by Agatston score^a.

<p>25(OH)D, 25-hydroxyvitamin D; PTH, parathyroid hormone; HDL, High-density lipoprotein; LDL, Low-density lipoprotein, VLDL, very low-density lipoprotein, eGFR, estimated GFR.</p>a<p>Normally distributed variables are expressed as mean ± SD and non-normally distributed variables are expressed as median (IQR).</p

Univariate and multivariate logistic regression of the risk of having a Friesinger score higher than the median (4 points).

<p>Univariate and multivariate logistic regression of the risk of having a Friesinger score higher than the median (4 points).</p

The deceptive concept of hypoparathyroidism and recurrence after parathyroidectomy in dialysis patients: are we offering a Procrustean bed to some patients?

ABSTRACT Objective: to analyze the frequency of hypoparathyroidism and of its recurrence after parathyroidectomy in dialysis patients according to different existing classifications. Methods: we conducted a retrospective study of 107 consecutive dialysis patients undergoing total parathyroidectomy with immediate autograft in a tertiary hospital from 2006 to 2010. We studied the changes in PTH levels in the postoperative period over time. Were grouped patients according to different PTH levels targets recommended according to the dosage method and by the American and Japanese Nephrology Societies, and by an International Experts Consortium. Results: after parathyroidectomy, there was sustained reduction in serum calcium and phosphatemia. The median value of PTH decreased from 1904pg/ml to 55pg/ml in 12 months. Depending on the considered target level, the proportion of patients below the target ranged between 17% and 87%. On the other hand, the proportion of patients with levels above the target ranged from 3% to 37%. Conclusion: the application of different recommendations for PTH levels after parathyroidectomy in dialysis patients may lead to incorrect classifications of hypoparathyroidism or recurrent hyperparathyroidism and resultin discordant therapeutic conducts

Univariate and multivariate logistic regression analysis of the risk of having an Agatston score >10.

<p>Univariate and multivariate logistic regression analysis of the risk of having an Agatston score >10.</p

Basic characteristics of the study population^a.

<p>BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; 25(OH)D, 25-hydroxyvitamin D; HDL, High-density lipoprotein; LDL, Low-density lipoprotein; VLDL, very low-density lipoprotein; eGFR, estimated GFR.</p>a<p>Normally distributed variables are expressed as mean ± SD and non-normally distributed variables are expressed as median (IQR).</p

Agatston scores by serum phosphorus tertiles.

<p>Results are expressed as medians. Agatston scores were progressively higher across phosphorus tertiles (<i>P</i> = 0.01).</p