High Serum Phosphate Tied To Renal Disease Progression

Increases risk of disease progression, decreases renoprotective effect of ACE inhibitors

WEDNESDAY, Aug. 24 (HealthDay News) -- Serum phosphate is an independent risk factor for progression of renal disease in patients with proteinuric chronic kidney disease (CKD) and may reduce the renoprotective effect of ACE inhibitors, according to a study published online Aug. 18 in the Journal of the American Society of Nephrology.

Carmine Zoccali, M.D., from Ospedali Riuniti in Italy, and colleagues evaluated the association between baseline serum phosphate levels, disease progression, and response to ACE inhibition in 331 patients with proteinuric nephropathies enrolled in the prospective Ramipril Efficacy In Nephropathy trial.

The investigators found that compared to patients with levels below the median, patients with phosphate levels in the highest two quartiles progressed significantly faster either to end stage renal disease (ESRD) or to a composite end point of ESRD or doubling of serum creatinine, independent of treatment. Results were similar upon analyzing phosphate as a continuous variable. Increasing serum phosphate decreased the renoprotective effect of ramipril and this effect persisted even after adjusting for potential confounders including glomerular filtration rate and urinary protein.

"These data suggest that phosphate is an independent risk factor for progression of renal disease among patients with proteinuric CKD, and high levels of phosphate may even attenuate the renoprotective effect of ACE inhibitors," the authors write.

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