Serum Levels of Phosphorus, Parathyroid Hormone, and Calcium and Risks of Death and Cardiovascular Disease in Individuals With Chronic Kidney Disease: A Systematic Review and Meta-analysis
Open accessAbstract
CONTEXT: Clinical practice guidelines on the management of mineral and bone disorders due to chronic kidney disease recommend specific treatment target levels for serum phosphorus, parathyroid hormone, and calcium. OBJECTIVE: To assess the quality of evidence for the association between levels of serum phosphorus, parathyroid hormone, and calcium and risks of death, cardiovascular mortality, and nonfatal cardiovascular events in individuals with chronic kidney disease. DATA SOURCES: The databases of MEDLINE (1948 to December 2010) and EMBASE (1947 to December 2010) were searched without language restriction. Hand searches also were conducted of the reference lists of primary studies, review articles, and clinical guidelines along with full-text review of any citation that appeared relevant. STUDY SELECTION: Of 8380 citations identified in the original search, 47 cohort studies (N = 327,644 patients) met the inclusion criteria. DATA EXTRACTION: The characteristics of study design, participants, exposures, and covariates together with the outcomes of all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular events at different levels of serum phosphorus, parathyroid hormone, and calcium were analyzed within studies. Data were summarized across studies (when possible) using random-effects meta-regression. DATA SYNTHESIS: The risk of death increased 18% for every 1-mg/dL increase in serum phosphorus (relative risk [RR], 1.18 [95% confidence interval {CI}, 1.12-1.25]). There was no significant association between all-cause mortality and serum level of parathyroid hormone (RR per 100-pg/mL increase, 1.01 [95% CI, 1.00-1.02]) or serum level of calcium (RR per 1-mg/dL increase, 1.08 [95% CI, 1.00-1.16]). Data for the association between serum level of phosphorus, parathyroid hormone, and calcium and cardiovascular death were each available in only 1 adequately adjusted cohort study. Lack of adjustment for confounding variables was not a major limitation of the available studies. CONCLUSIONS: The evidentiary basis for a strong, consistent, and independent association between serum levels of calcium and parathyroid hormone and the risk of death and cardiovascular events in chronic kidney disease is poor. There appears to be an association between higher serum levels of phosphorus and mortality in this population.
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Behavioural interventions to promote weight loss in people with type 2 diabetes reduce the risk of developing very high-risk chronic kidney disease over the long term.
“A raised BMI is independently associated with risk of CKD, and behavioural interventions to promote weight loss in people with T2DM reduce the risk of developing very high-risk CKD over the long-term.57,695,696”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [696]
A raised BMI is independently associated with risk of chronic kidney disease.
“A raised BMI is independently associated with risk of CKD, and behavioural interventions to promote weight loss in people with T2DM reduce the risk of developing very high-risk CKD over the long-term.57,695,696”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [696]
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- Authors
- Palmer, S. C.
- Affiliations
- University of Otago (NZ)
- Corresponding author
- Palmer, Suetonia C.
- ORCID
- Palmer, Suetonia C.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2011-03-16
- Volume
- 305
- Issue
- 11
- Pages
- 1119
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2090458713
- Cited by
- 721
- References
- 87
- Citations by year
- 2026: 46 · 2025: 25 · 2024: 35 · 2023: 24 · 2022: 40 · 2021: 52 · 2020: 42 · 2019: 40 · 2018: 43 · 2017: 57 · 2016: 46 · 2015: 88 · 2014: 50 · 2013: 62 · 2012: 43
- FWCI
- 44.80
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
- Keywords
- chronic kidney disease, serum phosphorus, parathyroid hormone, serum calcium, mineral and bone disorder, all-cause mortality, cardiovascular mortality, cardiovascular events, treatment goals, quality of evidence, confounding adjustment, meta-regression, cohort studies, quality of evidence grading, cardiovascular risk, hyperphosphatemia, secondary hyperparathyroidism, hypocalcemia
- MeSH terms
- Calcium, Cardiovascular Diseases, Humans, Kidney Failure, Chronic, Metabolic Diseases, Mortality, Parathyroid Hormone, Phosphorus, Predictive Value of Tests, Prognosis, Risk Factors, United States, Biomarkers, Practice Guidelines as Topic
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