Calcium, phosphate and calcium phosphate product are markers of outcome in patients with chronic heart failure

Calcium, phosphate and calcium phosphate product are markers of outcome in patients with chronic heart failure

Background Serum calcium (Ca) and inorganic phosphate (Pi) concentrations and calcium-phosphate product (CPP) levels are positively associated with worse outcomes in patients with chronic kidney disease, but there are few data for Pi or Ca and none for CPP in patients with chronic heart failure (CHF...

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Published in:Journal of nephrology Vol. 28; no. 2; pp. 209 - 215
Main Authors: Cubbon, Richard M., Thomas, Ceri Haf, Drozd, Michael, Gierula, John, Jamil, Haqeel A., Byrom, Rowenna, Barth, Julian H., Kearney, Mark T., Witte, Klaus K. A.
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01-04-2015
Subjects:
Aged
Biomarkers - blood
Calcium - blood
Chronic Disease
Disease Progression
Female
Heart Failure - blood
Heart Failure - etiology
Heart Failure - mortality
Hospitalization
Humans
Male
Medicine
Medicine & Public Health
Nephrology
Original Article
Phosphates - blood
Prognosis
Prospective Studies
Stroke Volume
Urology
Ventricular Dysfunction, Left - blood
Ventricular Dysfunction, Left - complications
Ventricular Dysfunction, Left - physiopathology
Heart failure
Calcium
Left ventricular dysfunction
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Summary:Background Serum calcium (Ca) and inorganic phosphate (Pi) concentrations and calcium-phosphate product (CPP) levels are positively associated with worse outcomes in patients with chronic kidney disease, but there are few data for Pi or Ca and none for CPP in patients with chronic heart failure (CHF). Methods Unselected, consecutive patients with CHF (left ventricular ejection fraction, LVEF ≤45 %) were enrolled in a prospective observational study for the occurrence of hospitalisation and mortality. Blood samples were collected at the time of recruitment and analysed immediately. Results Patients (n = 713) were on contemporary optimal treatment and mean (standard error, SE) follow-up was 765 (18.9) days. Mean (SE) Ca was 2.29 (0.004) mmol/l. Median (interquartile range, IQR) Pi was 1.11 (0.98–1.23) mmol/l and median CPP 2.53 (2.21–2.88) mmol 2 /l 2 . LVEF correlated inversely with Ca, natural log-transformed (Ln)Pi, and LnCPP. There was no difference in CPP between classes of symptom severity or diabetes status. Ca and LnCPP (but not LnPi) were associated with total mortality. Ca was significantly associated with progressive HF and non-cardiovascular death but not with sudden death. Binary logistic regression analyses showed that LnPi and LnCPP were associated with risk of hospitalisation. Conclusions Ca, Pi and CPP could be useful additional variables in determining risk in CHF patients. Further work is required to elucidate the mechanisms underlying the adverse influence and determine whether lowering phosphate levels per se in CHF patients is of benefit.
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ISSN:1121-8428
1724-6059
DOI:10.1007/s40620-014-0075-y