Abstract: TH-PO155
Target Serum Phosphate and Calcium Levels in Patients With CKD Undergoing Hemodialysis Receiving Prescriptions for Phosphate Binders: A Post Hoc Analysis of the LANDMARK Study
Session Information
- CKD-MBD: Targets and Outcomes
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Yoshida, Kiryu, Showa Daigaku, Shinagawa, Tokyo, Japan
- Mizukami, Takuya, Showa Daigaku, Shinagawa, Tokyo, Japan
- Fukagawa, Masafumi, Tokai Daigaku, Isehara, Kanagawa, Japan
- Akizawa, Tadao, Showa Daigaku, Shinagawa, Tokyo, Japan
- Morohoshi, Hokuto, Showa Daigaku, Shinagawa, Tokyo, Japan
- Sambe, Takehiko, Showa Daigaku, Shinagawa, Tokyo, Japan
- Ogata, Hiroaki, Showa Daigaku Yokohama-shi Hokubu Byoin, Yokohama, Kanagawa, Japan
- Uchida, Naoki, Showa Daigaku, Shinagawa, Tokyo, Japan
Background
In contemporary CKD-MBD management, there is a need to reexamine optimal target values for phosphate (P) and calcium (Ca) to reduce cardiovascular event risk in patients on hemodialysis.
Methods
We performed a post-hoc analysis of the LANDMARK study. The outcomes were defined as cardiovascular events and all-cause death. 2135 patients on hemodialysis at risk for vascular calcification were analyzed using the time-dependent Cox proportional hazards model.
Results
In stratified analysis, there was no difference in cardiovascular events between the lower half of the target range (3.5 - 4.8 mg/dL) and the higher half (4.8 - 6.0 mg/dL) for P (adjusted HR 1.18 (95% CI 0.86 - 1.63; p = 0.309)). For corrected Ca, the risk was higher in the higher half of the target range (9.2 - 10.0 mg/dL) than in the lower half (8.4 - 9.2 mg/dL) (adjusted HR 1.84 (95%CI 1.38 - 2.45; p < 0.001)). There was no difference in all-cause mortality between the lower half and the higher half of the target range for P or corrected Ca.
Conclusion
Stricter management of P alone was not associated with cardiovascular events in patients on hemodialysis. On the other hand, stricter management of Ca may reduce cardiovascular risk.
Results of Time-Dependent Cox Proportional Hazards Model
| Outcome | Variables | Number of observation points | Hazard Ratio (95% Confidence Interval) | P value |
| Cardiovascular events | Phosphate (mg/dL) | |||
| 3.5 - 4.8 | 2920 | 1.00 (reference) | ||
| 4.8 - 6.0 | 3716 | 1.18 (0.86 - 1.63) | 0.309 | |
| Corrected Calcium (mg/dL) | ||||
| 8.4 - 9.2 | 4263 | 1.00 (reference) | ||
| 9.2 - 10.0 | 3655 | 1.84 (1.38 - 2.45) | <0.001 | |
| All-cause mortality | Phosphate (mg/dL) | |||
| 3.5 - 4.8 | 2944 | 1.00 (reference) | ||
| 4.8 - 6.0 | 3819 | 0.94 (0.70 - 1.27) | 0.709 | |
| Corrected Calcium (mg/dL) | ||||
| 8.4 - 9.2 | 4379 | 1.00 (reference) | ||
| 9.2 - 10.0 | 3771 | 1.24 (0.94 - 1.63) | 0.133 |