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Study Questions Tests Used to Spot Heart Risks in Kidney Patients
Date:3/15/2011

and heart disease remains a major cause of death in people with chronic kidney disease.

Current clinical practice guidelines recommend testing for phosphorus, calcium and parathyroid levels in the blood, and treating abnormal levels of these biomarkers.

For the current study, the researchers reviewed all available literature from 1947 through 2010. They found 47 studies of these biomarkers to include in their analysis.

The team found that the risk of death increased 18 percent for each 1 milligram per deciliter increase in serum [blood] phosphorous. However, they found no association between mortality and parathyroid hormone levels or calcium levels.

Strippoli added that there were no good studies conducted to assess whether or not the treatment of high phosphorus levels could have an impact on the risk of death.

"The idea that we can measure things in the blood in people with chronic kidney disease and make very informed, individualized treatment decisions for patients should be dispelled," said Dr. Bryan Kestenbaum, author of an accompanying editorial in the same issue of the journal.

There are plausible biological reasons for suspecting that phosphorous and calcium could increase the risk of heart disease, as they may affect the flexibility of vessel walls. Parathyroid hormone can have direct effects on heart cells and may make them grow abnormally, he explained, but added that no one can show a direct cause-and-effect relationship for any of these substances.

"Even though this analysis found an association between increased phosphorus levels and mortality, we just don't know if there's cause and effect. Is it the phosphate that causes the increased risk, or is it something about people with high phosphate levels that makes them have a higher risk?" said Kestenbaum, an associate professor in medicine and epidemiology at the Kidney Research Institute at the University of Washington in Seattle.

He added that th
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