What is it about?
Hyperphosphatemia has been reported to be associated with severity of coronary artery calcification (CAC), a predictor of all-cause mortality in incident patients on hemodialysis. However, the optimal phosphate range in such patients remains unknown. The authors conducted a randomized study to compare the effects on CAC progression of two types of noncalcium-based phosphate binders (sucroferric oxyhydroxide or lanthanum carbonate) and of two different phosphate target ranges. The percentage change in CAC score in a strict phosphate control group (3.5–4.5 mg/dl) was significantly lower than that in a standard phosphate control group (5.0–6.0mg/dl). The phosphate binders did not differ in their effects on CAC progression. Further study with a larger sample size is needed, but strict phosphate control shows promise for delaying CAC progression in patients on hemodialysis.
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Why is it important?
EPISODE study showed for the first time that strict phosphate control toward the normal range delayed the progression of CAC in dialysis patients.
Perspectives
A future study should address whether strict phosphate control, as well as an iron-based phosphate binder, could improve the hard outcomes, such as cardiovascular events and mortality, in dialysis patients.
YOSHITAKA ISAKA
Osaka Daigaku
Read the Original
This page is a summary of: Optimal Phosphate Control Related to Coronary Artery Calcification in Dialysis Patients, Journal of the American Society of Nephrology, February 2021, American Society of Nephrology,
DOI: 10.1681/asn.2020050598.
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