A STUDY TO CORRELATE SERUM PHOSPHORUS WITH MARKER OF ENDOTHELIAL CELL DYSFUNCTION IN CHRONIC KIDNEY DISEASE PATIENTS ON MAINTENANCE HAEMODIALYSIS.

Introduction:

Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) is a systemic condition characterized by disturbances in mineral and bone metabolism due to chronic kidney disease (CKD). As the glomerular filtration rate declines, phosphate excretion diminishes, leading to elevated serum phosphate levels. Hyperphosphatemia profoundly affects vascular cell behavior and function and is associated with cardiovascular diseases, particularly through vascular calcifications in CKD patients [1]. Research indicates that high serum phosphate levels can impair endothelial function by reducing nitric oxide (NO) release through the inhibitory phosphorylation of endothelial nitric oxide synthase (eNOS) [2]. Hyperphosphatemia also decreases intracellular calcium, increases protein kinase C activity, reduces cell viability, and enhances apoptosis [3].

Endothelin-1 (ET-1) is a potent vasoconstrictor peptide secreted by endothelial cells and has notable pro-inflammatory, mitogenic, and proliferative effects. It also promotes excessive free radical formation and platelet activation. This study aims to determine the direct correlation between serum phosphate levels and endothelial dysfunction, as indicated by serum endothelin-1 levels.

Methods:

In this prospective cohort study, 37 participants with CKD stage 5 undergoing maintenance hemodialysis were enrolled, all of whom had recent reports of hyperphosphatemia. Following informed consent, serum phosphate levels (measured using the phosphomolybdate complex method) and endothelin-1 levels (measured using the ELISA method) were assessed. Hyperphosphatemia was managed with dietary modifications and sevelamer at doses of 1200 to 2400 mg. After 6 months, serum phosphate and endothelin-1 levels were re-evaluated, and changes in their values were recorded. Statistical analysis was conducted using SPSS software, and Spearman's correlation was employed to analyze the relationship between changes in serum phosphate and endothelin-1 levels.

Results:

Conclusions:

A significant positive correlation was observed between changes in serum phosphate and endothelin-1 levels (p < 0.001). 

This study indicates that hyperphosphatemia is associated with endothelial dysfunction, as measured by serum endothelin-1 levels. Chronic endothelial dysfunction can lead to vascular complications such as calcification and accelerated atherosclerosis.

 Hyperphosphatemia is a modifiable factor, especially in dialysis patients. Early correction of hyperphosphatemia may help prevent further complications.

References:

1. Kovesdy CP, et al. Hyperphosphatemia and mortality in patients with chronic kidney disease. Kidney Int. 2007;71:438-441. 

2.Kestenbaum B, et al. Phosphorus and cardiovascular risk in chronic kidney disease. J Am Soc Nephrol. 2005;16:520-528.

3. Bleyer AJ, et al. The effects of phosphate on endothelial cell function. Nephrol Dial Transplant. 2009;24:271-277.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.