Martín Marisa, Valls Joan, Betriu Angels, Fernández Elvira, Valdivielso Jose M
Nephrology Service and Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Hospital Universitari Arnau de Vilanova, IRBLLEIDA. Av. Rovira Roure 80, 25198 Lleida, Spain.
Biostatistics Unit, IRBLLEIDA. Av. Rovira Roure 80, 25198 Lleida, Spain.
Atherosclerosis. 2015 Jul;241(1):264-70. doi: 10.1016/j.atherosclerosis.2015.02.048. Epub 2015 Feb 28.
Cardiovascular disease is the leading cause of mortality in chronic kidney disease (CKD). Serum phosphate has been associated to cardiovascular disease in the general population and this effect seems to be different according to sex. In the present study we analyze the effect of phosphate on subclinical atherosclerosis in the NEFRONA population and its effect depending on sex.
Carotid ultrasound assessing the presence of plaques was performed by an itinerant team in 1687 CKD patients not in dialysis without previous cardiovascular events. Standard blood test and anthropometrical parameters were also recorded.
Multivariate linear regression to model phosphate levels in patients with CKD showed an interaction of sex with age. Thus, among men, serum phosphate levels declined significantly with age almost linearly. Serum phosphate levels in women under the age of 40-45 years overlapped with those in men and then stayed above, showing and overall constant relationship. Multivariate logistic regression analysis showed that higher phosphate levels associated with a higher risk of presenting atheromatous plaque. This risk however was different according to sex. In men, phosphate levels within the normal range associated with an increased risk of subclinical atheromatosis whereas in women this risk only increased with serum levels over the normal range.
This study demonstrates that phosphate levels are associated with the presence of subclinical atheromatosis in a large CKD population. This effect of phosphate on subclinical atheromatosis was different according to sex, suggesting that a recommended serum phosphate levels could be different for male than for female CKD patients.
心血管疾病是慢性肾脏病（CKD）患者死亡的主要原因。血清磷与普通人群的心血管疾病有关，而且这种影响似乎因性别而异。在本研究中，我们分析了磷对NEFRONA队列中亚临床动脉粥样硬化的影响及其性别差异。
一个巡回小组对1687例未接受透析且无既往心血管事件的CKD患者进行了颈动脉超声检查，以评估斑块的存在情况。同时记录了标准血液检测和人体测量参数。
对CKD患者的磷水平进行多变量线性回归分析显示，性别与年龄存在交互作用。因此，在男性中，血清磷水平几乎随年龄呈线性显著下降。40 - 45岁以下女性的血清磷水平与男性重叠，之后高于男性，呈现总体稳定的关系。多变量逻辑回归分析表明，较高的磷水平与动脉粥样斑块形成风险增加相关。然而，这种风险因性别而异。在男性中，正常范围内的磷水平与亚临床动脉粥样硬化风险增加相关，而在女性中，只有血清磷水平超过正常范围时，这种风险才会增加。
本研究表明，在大量CKD人群中，磷水平与亚临床动脉粥样硬化的存在相关。磷对亚临床动脉粥样硬化的这种影响因性别而异，这表明对于男性和女性CKD患者，推荐的血清磷水平可能不同。
