High Phosphorus Linked to Coronary Calcification in CKD

WASHINGTON—Higher levels of phosphorus in the blood are associated with increased calcification of the major arteries and heart valves and may contribute to the increased risk of cardiovascular disease for patients with moderate chronic kidney disease, according to a study in the February 2009 issue of the Journal of the American Society of Nephrology.

"Previous studies have found that a very high level of phosphorus in the blood can lead to cardiovascular disease and vascular calcification in dialysis patients," said Bryan Kestenbaum, MD, of the University of Washington in Seattle, Washington, one of the authors of the new study. "We are now recognizing that even a mild increase in the serum phosphorus level is associated with cardiovascular events in people with CKD who are not on dialysis."

The researchers looked at the relationship between blood phosphorus levels and vascular (blood vessel) calcification in a group of 439 patients with moderate CKD. Patients with CKD have loss of kidney function that, in many cases, progresses to end-stage renal disease. Detected by a special computed tomography (CT) scan, vascular calcification is an indicator of overall atherosclerosis ("hardening of the arteries"). Coronary artery calcification is also linked to an increased risk of cardiovascular events, such as myocardial infarction (heart attack).

The CT scans showed calcifications of the coronary arteries in two-thirds of the CKD patients. Ninety-five percent of the patients had phosphorus levels within the normal range—between 2.5 and 4.5 milligrams per deciliter (mg/dL).

Even within this normal range, patients with higher phosphorus levels were more likely to have vascular calcification. For each 1 mg/dL increase in phosphorus level, the risk of coronary artery calcification increased by 21 percent, after adjustment for level of kidney function and other characteristics.