Serum phosphate optimal timing and range associated with patients survival in haemodialysis: The COSMOS study

José L. Fernández-Martín; Adriana Dusso; Pablo Martínez-Camblor; Maria P. Dionisi; Jürgen Floege; Markus Ketteler; Gérard London; Francesco Locatelli; José L. Górriz; Boleslaw Rutkowski; Willem Jan Bos; Christian Tielemans; Pierre Yves Martin; Rudolf P. Wüthrich; Drasko Pavlovic; Miha Benedik; Diego Rodríguez-Puyol; Juan J. Carrero; Carmine Zoccali; Jorge B. Cannata-Andía; Adrian Covic; Aníbal Ferreira; David Goldsmith; Reinhard Kramar; Dimitrios Memmos; Judit Nagy; Vladimir Teplan; Dierik Verbeelen; José Luis Motellón; Matthew Turner; Julien Chaussy; Bart Molemans; Wal Zani; Dylan Rosser; Bastian Dehmel; Bruno Fouqueray; Brian Bradbury; John Acquavella; Jennifer Hollowell; Dave Carter; Phil Holland; Ana Baños; Caroline Mattin; Cathy Critchlow; Joseph Kim; Charlotte Lewis; Antonia Panayi; Margit Hemetsberger; Stephen Croft; Philippe Jaeger; Prisca Muehlebach; Jane Blackburn; Esther Zumsteg; Silvia Rodríguez; Angel Pérez; Pau Faner; Irantzu Izco; Susana Traseira; Carmen Castro; Javier Moreno; David Calle; Francesca Pieraccini

doi:10.1093/ndt/gfy093

Serum phosphate optimal timing and range associated with patients survival in haemodialysis: The COSMOS study

José L. Fernández-Martín, Adriana Dusso, Pablo Martínez-Camblor, Maria P. Dionisi, Jürgen Floege, Markus Ketteler, Gérard London, Francesco Locatelli, José L. Górriz, Boleslaw Rutkowski, Willem Jan Bos, Christian Tielemans, Pierre Yves Martin, Rudolf P. Wüthrich, Drasko Pavlovic, Miha Benedik, Diego Rodríguez-Puyol, Juan J. Carrero, Carmine Zoccali, Jorge B. Cannata-AndíaAdrian Covic, Aníbal Ferreira, David Goldsmith, Reinhard Kramar, Dimitrios Memmos, Judit Nagy, Vladimir Teplan, Dierik Verbeelen, José Luis Motellón, Matthew Turner, Julien Chaussy, Bart Molemans, Wal Zani, Dylan Rosser, Bastian Dehmel, Bruno Fouqueray, Brian Bradbury, John Acquavella, Jennifer Hollowell, Dave Carter, Phil Holland, Ana Baños, Caroline Mattin, Cathy Critchlow, Joseph Kim, Charlotte Lewis, Antonia Panayi, Margit Hemetsberger, Stephen Croft, Philippe Jaeger, Prisca Muehlebach, Jane Blackburn, Esther Zumsteg, Silvia Rodríguez, Angel Pérez, Pau Faner, Irantzu Izco, Susana Traseira, Carmen Castro, Javier Moreno, David Calle, Francesca Pieraccini

NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)

Research output: Contribution to journal › Article › peer-review

22 Citations (Scopus)

Abstract

Background. Serum phosphate is a key parameter in the management of chronic kidney disease-mineral and bone disorder (CKD-MBD). The timing of phosphate measurement is not standardized in the current guidelines. Since the optimal range of these biomarkers may vary depending on the duration of the interdialytic interval, in this analysis of the Current management of secondary hyperparathyroidism: a multicentre observational study (COSMOS), we assessed the influence of a 2- (midweek) or 3-day (post-weekend) dialysis interval for blood withdrawal on serum levels of CKD-MBD biomarkers and their association with mortality risk. Methods. The COSMOS cohort (6797 patients, CKD Stage 5D) was divided into two groups depending upon midweek or post-weekend blood collection. Univariate and multivariate Cox's models adjusted hazard ratios (HRs) by demographics and comorbidities, treatments and biochemical parameters from a patient/centre database collected at baseline and every 6 months for 3 years. Results. There were no differences in serum calcium or parathyroid hormone levels between midweek and post-weekend patients. However, in post-weekend patients, the mean serum phosphate levels were higher compared with midweek patients (5.5 ± 1.4 versus 5.2 ± 1.4 mg/dL, P < 0.001). Also, the range of serum phosphate with the lowest mortality risk [HR ≤ 1.1; midweek: 3.5-4.9 mg/dL (95% confidence interval, CI: 2.9-5.2 mg/dL); post-weekend: 3.8-5.7 mg/dL (95% CI: 3.0-6.4 mg/dL)] showed significant differences in the upper limit (P = 0.021). Conclusion. Midweek and post-weekend serum phosphate levels and their target ranges associated with the lowest mortality risk differ. Thus, clinical guidelines should consider the timing of blood withdrawal when recommending optimal target ranges for serum phosphate and therapeutic strategies for phosphate control.

Original language	English
Pages (from-to)	673-681
Number of pages	9
Journal	Nephrology Dialysis Transplantation
Volume	34
Issue number	4
DOIs	https://doi.org/10.1093/ndt/gfy093
Publication status	Published - 1 Jan 2019

Keywords

calcaemia
chronic haemodialysis
epidemiology
hyperparathyroidism
phosphataemia

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10.1093/ndt/gfy093

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Fernández-Martín, J. L., Dusso, A., Martínez-Camblor, P., Dionisi, M. P., Floege, J., Ketteler, M., London, G., Locatelli, F., Górriz, J. L., Rutkowski, B., Bos, W. J., Tielemans, C., Martin, P. Y., Wüthrich, R. P., Pavlovic, D., Benedik, M., Rodríguez-Puyol, D., Carrero, J. J., Zoccali, C., ... Pieraccini, F. (2019). Serum phosphate optimal timing and range associated with patients survival in haemodialysis: The COSMOS study. Nephrology Dialysis Transplantation, 34(4), 673-681. https://doi.org/10.1093/ndt/gfy093

@article{d1f0b92f22714e7386ff76a7e15e3dd7,

title = "Serum phosphate optimal timing and range associated with patients survival in haemodialysis: The COSMOS study",

abstract = "Background. Serum phosphate is a key parameter in the management of chronic kidney disease-mineral and bone disorder (CKD-MBD). The timing of phosphate measurement is not standardized in the current guidelines. Since the optimal range of these biomarkers may vary depending on the duration of the interdialytic interval, in this analysis of the Current management of secondary hyperparathyroidism: a multicentre observational study (COSMOS), we assessed the influence of a 2- (midweek) or 3-day (post-weekend) dialysis interval for blood withdrawal on serum levels of CKD-MBD biomarkers and their association with mortality risk. Methods. The COSMOS cohort (6797 patients, CKD Stage 5D) was divided into two groups depending upon midweek or post-weekend blood collection. Univariate and multivariate Cox's models adjusted hazard ratios (HRs) by demographics and comorbidities, treatments and biochemical parameters from a patient/centre database collected at baseline and every 6 months for 3 years. Results. There were no differences in serum calcium or parathyroid hormone levels between midweek and post-weekend patients. However, in post-weekend patients, the mean serum phosphate levels were higher compared with midweek patients (5.5 ± 1.4 versus 5.2 ± 1.4 mg/dL, P < 0.001). Also, the range of serum phosphate with the lowest mortality risk [HR ≤ 1.1; midweek: 3.5-4.9 mg/dL (95% confidence interval, CI: 2.9-5.2 mg/dL); post-weekend: 3.8-5.7 mg/dL (95% CI: 3.0-6.4 mg/dL)] showed significant differences in the upper limit (P = 0.021). Conclusion. Midweek and post-weekend serum phosphate levels and their target ranges associated with the lowest mortality risk differ. Thus, clinical guidelines should consider the timing of blood withdrawal when recommending optimal target ranges for serum phosphate and therapeutic strategies for phosphate control.",

keywords = "calcaemia, chronic haemodialysis, epidemiology, hyperparathyroidism, phosphataemia",

author = "Fern{\'a}ndez-Mart{\'i}n, {Jos{\'e} L.} and Adriana Dusso and Pablo Mart{\'i}nez-Camblor and Dionisi, {Maria P.} and J{\"u}rgen Floege and Markus Ketteler and G{\'e}rard London and Francesco Locatelli and G{\'o}rriz, {Jos{\'e} L.} and Boleslaw Rutkowski and Bos, {Willem Jan} and Christian Tielemans and Martin, {Pierre Yves} and W{\"u}thrich, {Rudolf P.} and Drasko Pavlovic and Miha Benedik and Diego Rodr{\'i}guez-Puyol and Carrero, {Juan J.} and Carmine Zoccali and Cannata-And{\'i}a, {Jorge B.} and Adrian Covic and An{\'i}bal Ferreira and David Goldsmith and Reinhard Kramar and Dimitrios Memmos and Judit Nagy and Vladimir Teplan and Dierik Verbeelen and Motell{\'o}n, {Jos{\'e} Luis} and Matthew Turner and Julien Chaussy and Bart Molemans and Wal Zani and Dylan Rosser and Bastian Dehmel and Bruno Fouqueray and Brian Bradbury and John Acquavella and Jennifer Hollowell and Dave Carter and Phil Holland and Ana Ba{\~n}os and Caroline Mattin and Cathy Critchlow and Joseph Kim and Charlotte Lewis and Antonia Panayi and Margit Hemetsberger and Stephen Croft and Philippe Jaeger and Prisca Muehlebach and Jane Blackburn and Esther Zumsteg and Silvia Rodr{\'i}guez and Angel P{\'e}rez and Pau Faner and Irantzu Izco and Susana Traseira and Carmen Castro and Javier Moreno and David Calle and Francesca Pieraccini",

year = "2019",

month = jan,

day = "1",

doi = "10.1093/ndt/gfy093",

language = "English",

volume = "34",

pages = "673--681",

journal = "Nephrology Dialysis Transplantation",

issn = "0931-0509",

publisher = "European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) | Oxford University Press ",

number = "4",

}

Fernández-Martín, JL, Dusso, A, Martínez-Camblor, P, Dionisi, MP, Floege, J, Ketteler, M, London, G, Locatelli, F, Górriz, JL, Rutkowski, B, Bos, WJ, Tielemans, C, Martin, PY, Wüthrich, RP, Pavlovic, D, Benedik, M, Rodríguez-Puyol, D, Carrero, JJ, Zoccali, C, Cannata-Andía, JB, Covic, A, Ferreira, A, Goldsmith, D, Kramar, R, Memmos, D, Nagy, J, Teplan, V, Verbeelen, D, Motellón, JL, Turner, M, Chaussy, J, Molemans, B, Zani, W, Rosser, D, Dehmel, B, Fouqueray, B, Bradbury, B, Acquavella, J, Hollowell, J, Carter, D, Holland, P, Baños, A, Mattin, C, Critchlow, C, Kim, J, Lewis, C, Panayi, A, Hemetsberger, M, Croft, S, Jaeger, P, Muehlebach, P, Blackburn, J, Zumsteg, E, Rodríguez, S, Pérez, A, Faner, P, Izco, I, Traseira, S, Castro, C, Moreno, J, Calle, D & Pieraccini, F 2019, 'Serum phosphate optimal timing and range associated with patients survival in haemodialysis: The COSMOS study', Nephrology Dialysis Transplantation, vol. 34, no. 4, pp. 673-681. https://doi.org/10.1093/ndt/gfy093

TY - JOUR

T1 - Serum phosphate optimal timing and range associated with patients survival in haemodialysis

T2 - The COSMOS study

AU - Fernández-Martín, José L.

AU - Dusso, Adriana

AU - Martínez-Camblor, Pablo

AU - Dionisi, Maria P.

AU - Floege, Jürgen

AU - Ketteler, Markus

AU - London, Gérard

AU - Locatelli, Francesco

AU - Górriz, José L.

AU - Rutkowski, Boleslaw

AU - Bos, Willem Jan

AU - Tielemans, Christian

AU - Martin, Pierre Yves

AU - Wüthrich, Rudolf P.

AU - Pavlovic, Drasko

AU - Benedik, Miha

AU - Rodríguez-Puyol, Diego

AU - Carrero, Juan J.

AU - Zoccali, Carmine

AU - Cannata-Andía, Jorge B.

AU - Covic, Adrian

AU - Ferreira, Aníbal

AU - Goldsmith, David

AU - Kramar, Reinhard

AU - Memmos, Dimitrios

AU - Nagy, Judit

AU - Teplan, Vladimir

AU - Verbeelen, Dierik

AU - Motellón, José Luis

AU - Turner, Matthew

AU - Chaussy, Julien

AU - Molemans, Bart

AU - Zani, Wal

AU - Rosser, Dylan

AU - Dehmel, Bastian

AU - Fouqueray, Bruno

AU - Bradbury, Brian

AU - Acquavella, John

AU - Hollowell, Jennifer

AU - Carter, Dave

AU - Holland, Phil

AU - Baños, Ana

AU - Mattin, Caroline

AU - Critchlow, Cathy

AU - Kim, Joseph

AU - Lewis, Charlotte

AU - Panayi, Antonia

AU - Hemetsberger, Margit

AU - Croft, Stephen

AU - Jaeger, Philippe

AU - Muehlebach, Prisca

AU - Blackburn, Jane

AU - Zumsteg, Esther

AU - Rodríguez, Silvia

AU - Pérez, Angel

AU - Faner, Pau

AU - Izco, Irantzu

AU - Traseira, Susana

AU - Castro, Carmen

AU - Moreno, Javier

AU - Calle, David

AU - Pieraccini, Francesca

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background. Serum phosphate is a key parameter in the management of chronic kidney disease-mineral and bone disorder (CKD-MBD). The timing of phosphate measurement is not standardized in the current guidelines. Since the optimal range of these biomarkers may vary depending on the duration of the interdialytic interval, in this analysis of the Current management of secondary hyperparathyroidism: a multicentre observational study (COSMOS), we assessed the influence of a 2- (midweek) or 3-day (post-weekend) dialysis interval for blood withdrawal on serum levels of CKD-MBD biomarkers and their association with mortality risk. Methods. The COSMOS cohort (6797 patients, CKD Stage 5D) was divided into two groups depending upon midweek or post-weekend blood collection. Univariate and multivariate Cox's models adjusted hazard ratios (HRs) by demographics and comorbidities, treatments and biochemical parameters from a patient/centre database collected at baseline and every 6 months for 3 years. Results. There were no differences in serum calcium or parathyroid hormone levels between midweek and post-weekend patients. However, in post-weekend patients, the mean serum phosphate levels were higher compared with midweek patients (5.5 ± 1.4 versus 5.2 ± 1.4 mg/dL, P < 0.001). Also, the range of serum phosphate with the lowest mortality risk [HR ≤ 1.1; midweek: 3.5-4.9 mg/dL (95% confidence interval, CI: 2.9-5.2 mg/dL); post-weekend: 3.8-5.7 mg/dL (95% CI: 3.0-6.4 mg/dL)] showed significant differences in the upper limit (P = 0.021). Conclusion. Midweek and post-weekend serum phosphate levels and their target ranges associated with the lowest mortality risk differ. Thus, clinical guidelines should consider the timing of blood withdrawal when recommending optimal target ranges for serum phosphate and therapeutic strategies for phosphate control.

AB - Background. Serum phosphate is a key parameter in the management of chronic kidney disease-mineral and bone disorder (CKD-MBD). The timing of phosphate measurement is not standardized in the current guidelines. Since the optimal range of these biomarkers may vary depending on the duration of the interdialytic interval, in this analysis of the Current management of secondary hyperparathyroidism: a multicentre observational study (COSMOS), we assessed the influence of a 2- (midweek) or 3-day (post-weekend) dialysis interval for blood withdrawal on serum levels of CKD-MBD biomarkers and their association with mortality risk. Methods. The COSMOS cohort (6797 patients, CKD Stage 5D) was divided into two groups depending upon midweek or post-weekend blood collection. Univariate and multivariate Cox's models adjusted hazard ratios (HRs) by demographics and comorbidities, treatments and biochemical parameters from a patient/centre database collected at baseline and every 6 months for 3 years. Results. There were no differences in serum calcium or parathyroid hormone levels between midweek and post-weekend patients. However, in post-weekend patients, the mean serum phosphate levels were higher compared with midweek patients (5.5 ± 1.4 versus 5.2 ± 1.4 mg/dL, P < 0.001). Also, the range of serum phosphate with the lowest mortality risk [HR ≤ 1.1; midweek: 3.5-4.9 mg/dL (95% confidence interval, CI: 2.9-5.2 mg/dL); post-weekend: 3.8-5.7 mg/dL (95% CI: 3.0-6.4 mg/dL)] showed significant differences in the upper limit (P = 0.021). Conclusion. Midweek and post-weekend serum phosphate levels and their target ranges associated with the lowest mortality risk differ. Thus, clinical guidelines should consider the timing of blood withdrawal when recommending optimal target ranges for serum phosphate and therapeutic strategies for phosphate control.

KW - calcaemia

KW - chronic haemodialysis

KW - epidemiology

KW - hyperparathyroidism

KW - phosphataemia

UR - http://www.scopus.com/inward/record.url?scp=85064578859&partnerID=8YFLogxK

U2 - 10.1093/ndt/gfy093

DO - 10.1093/ndt/gfy093

M3 - Article

C2 - 29741651

AN - SCOPUS:85064578859

SN - 0931-0509

VL - 34

SP - 673

EP - 681

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

IS - 4

ER -

Serum phosphate optimal timing and range associated with patients survival in haemodialysis: The COSMOS study

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