Higher Serum Phosphorus Is Not an Independent Risk Factor of Mortality in Heart Failure with Reduced Ejection Fraction.

Partyka Robert,Mroczek Alina,Malinowska-Borowska Jolanta,Gąsior Mariusz,Głogowska-Gruszka Anna,Buczkowska Marta,Rozentryt Piotr,Hudzik Bartosz,Niedziela Jacek,Duda Sylwia

doi:10.3390/nu13114004

Abstract

Higher serum phosphorus has detrimental health effects. Even high-normal rage sP is associated with worse outcomes. The relationship of serum phosphorus with prognostic markers in heart failure remains unclear. We investigated the association of serum phosphorus with heart failure prognostic factors and risk of mortality related to serum phosphorus. In 1029 stable heart failure patients, we investigated the distribution of markers of more advanced heart failure stage across quintiles of serum phosphorus and estimated the relative risk of mortality in comparison to reference. Higher serum phosphorus levels sP were associated with markers of a worse outcome. The best survival was observed in low-normal serum levels. The unadjusted hazard ratio for mortality increased toward higher phosphorus quintiles but not to lower levels of sP. The correction for age, sex, BMI, percent weight loss, inflammation, kidney function, and LVEF did not modify the risk profile substantially. The adjustment for NYHA, natriuretic peptides, serum sodium, and treatment characteristics broke down the risk relationship completely. A higher serum phosphorus is associated with markers of a more risky profile of heart failure. Elevated serum levels of phosphorus sP does not provide independent prognostic information beyond the strongest markers of the severity of the syndrome. The potential involvement of higher serum phosphorus as a mediator in the pathophysiology of heart failure warrants further study.

Highlights

Phosphorus is a key nutrient for living organisms
Bisphosphonates, vitamin D formulations, or calcium- or phosphorus-containing salts and those who had an active infection, liver disease with enzymes exceeding 4 times the upper reference limit, active bleeding, known neoplasm or granulomatous disease, and patients with a history of any surgery reducing gut absorption capacity were excluded from the study
We examined the influence of sex, age, Body mass indexes (BMI), weight loss, high sensitivity C-reactive protein (hsCRP), eGFRMDRD, and LVEF but not calcium on the association between serum phosphorus (sP) and mortality

Summary

Introduction

Phosphorus is a key nutrient for living organisms. The element is important for energy production, proper function of nucleic acids and enzymes, cell proliferation and signaling, and as a component of the skeleton [1,2]. Low serum phosphorus (sP) is a known risk factor for development of heart failure (HF) and aggravates clinical profile of existing. HF [3]; in patients with septic shock, reduced sP increases their morbidity and mortality [4]. Elevated sP is known to initiate cardiovascular remodeling and clinical events in renal patients [5,6]. In non-renal populations, even high-normal sP has been associated with accelerated atherosclerosis [7] and excessive morbidity and mortality [8,9,10]

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