1
|
Nan W, Huang Q, Wan J, Peng Z. Association of serum phosphate and changes in serum phosphate with 28-day mortality in septic shock from MIMIC-IV database. Sci Rep 2023; 13:21869. [PMID: 38072848 PMCID: PMC10711004 DOI: 10.1038/s41598-023-49170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
This study aimed to investigate the relationship between serum phosphate levels, changes in serum phosphate levels, and 28-day mortality in patients with septic shock. In this retrospective study, data were collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database between 2008 and 2019. Patients were divided into three groups according to the tertiles of serum phosphate levels. Kaplan-Meier curves and log-rank test analyses were used for survival analysis. Multivariate logistic regression, and restricted cubic spline (RCS) curve were used to explore the association between serum phosphate, delta serum phosphate levels and 28-day mortality. In total, 3296 patients with septic shock were included in the study, and the 28-day mortality was 30.0%. Serum phosphate levels were significantly higher in the non-survivor group than in the survivor group. The Kaplan-Meier curves showed significant differences among the three groups. Multivariate logistic regression analysis and the RCS curve showed that serum phosphate levels were independently and positively associated with the 28-day mortality of septic shock. Non-survivors had higher delta serum phosphate levels than survivors. Survival analysis showed that patients with higher delta serum phosphate levels had higher 28-day mortality. A non-linear relationship was detected between delta serum phosphate and 28-day mortality with a point of inflection at - 0.3 mg/dL. Serum phosphate levels were positively and independently associated with 28-day mortality in septic shock. Delta serum phosphate level was a high-risk factor for patients with septic shock.
Collapse
Affiliation(s)
- Wenbin Nan
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
- Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha, 410011, People's Republic of China
| | - Qiong Huang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
- Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha, 410011, People's Republic of China
- Department of Geriatric Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China
| | - Jinfa Wan
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
- Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha, 410011, People's Republic of China
| | - Zhenyu Peng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China.
- Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha, 410011, People's Republic of China.
| |
Collapse
|
2
|
Brown RB, Bigelow P, Dubin JA. Breast Cancer and Bone Mineral Density in a U.S. Cohort of Middle-Aged Women: Associations with Phosphate Toxicity. Cancers (Basel) 2023; 15:5093. [PMID: 37894460 PMCID: PMC10604967 DOI: 10.3390/cancers15205093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Breast cancer is associated with phosphate toxicity, the toxic effect from dysregulated phosphate metabolism that can stimulate tumorigenesis. Phosphate toxicity and dysregulated phosphate metabolism are also associated with bone mineral abnormalities, including excessive bone mineral loss and deposition. Based on shared associations with dysregulated phosphate metabolism and phosphate toxicity, a hypothesis proposed in the present mixed methods-grounded theory study posits that middle-aged women with incidence of breast cancer had a greater magnitude of changes in bone mineral density over time compared with women who remained cancer-free. To test this hypothesis, a mixed-effects model was used to analyze the associations of breast cancer incidence with spinal bone mineral density changes in the U.S. Study of Women's Health Across the Nation. Compared with women in the cohort who remained cancer-free, women who self-reported breast cancer had higher bone mineral density at baseline, but had more rapid losses in bone mineral density during follow-up visits. These findings agree with the hypothesis that a greater magnitude of changes in bone mineral density over time is associated with breast cancer in a cohort of middle-aged women. The findings also have implications for studies investigating dysregulated phosphate metabolism and phosphate toxicity as causative factors of bone metastasis in metastatic breast cancer. Additionally, the authors previously found increased breast cancer risk associated with high dietary phosphate intake in the same cohort of middle-aged women, and more studies should investigate a low-phosphorus diet to reduce bone mineral abnormalities and tumorigenesis in breast cancer patients.
Collapse
Affiliation(s)
- Ronald B. Brown
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (P.B.); (J.A.D.)
| | - Philip Bigelow
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (P.B.); (J.A.D.)
| | - Joel A. Dubin
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (P.B.); (J.A.D.)
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| |
Collapse
|
3
|
Calvo MS, Dunford EK, Uribarri J. Industrial Use of Phosphate Food Additives: A Mechanism Linking Ultra-Processed Food Intake to Cardiorenal Disease Risk? Nutrients 2023; 15:3510. [PMID: 37630701 PMCID: PMC10459924 DOI: 10.3390/nu15163510] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The consumption of ultra-processed food (UPF) keeps rising, and at the same time, an increasing number of epidemiological studies are linking high rates of consumption of UPF with serious health outcomes, such as cardiovascular disease, in the general population. Many potential mechanisms, either in isolation or in combination, can explain the negative effects of UPF. In this review, we have addressed the potential role of inorganic phosphate additives, commonly added to a wide variety of foods, as factors contributing to the negative effects of UPF on cardiorenal disease. Inorganic phosphates are rapidly and efficiently absorbed, and elevated serum phosphate can lead to negative cardiorenal effects, either directly through tissue/vessel calcification or indirectly through the release of mineral-regulating hormones, parathyroid hormone, and fibroblast growth factor-23. An association between serum phosphate and cardiovascular and bone disease among patients with chronic kidney disease is well-accepted by nephrologists. Epidemiological studies have demonstrated an association between serum phosphate and dietary phosphate intake and mortality, even in the general American population. The magnitude of the role of inorganic phosphate additives in these associations remains to be determined, and the initial step should be to determine precise estimates of population exposure to inorganic phosphate additives in the food supply.
Collapse
Affiliation(s)
- Mona S. Calvo
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Elizabeth K. Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia;
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jaime Uribarri
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| |
Collapse
|
4
|
Guo C, Su Y, He L, Zeng Z, Ding N. A non-linear positive relationship between serum phosphate and clinical outcomes in sepsis. Heliyon 2022; 8:e12619. [PMID: 36619439 PMCID: PMC9816969 DOI: 10.1016/j.heliyon.2022.e12619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/01/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to evaluate the possible relationship between serum phosphate and short-term outcomes in sepsis. Methods This was a retrospective study. Sepsis patients in MIMIC-IV database were included. Based on the quartiles of serum phosphate, all sepsis patients were divided into four groups. Univariable and multivariable regression analyses were constructed for discussing the relationship between different parameters and 30-day mortality in sepsis. A generalized additive model was performed for exploring the association of serum phosphate with 30-day mortality. Results 6251 sepsis patients including 4368 survivors and 1883 non-survivors were included. A significant relationship between serum phosphate and 30-day mortality was found after adjusting for all potential confounders (OR = 1.19, 95%CI:1.13-1.26, P < 0.0001). The relationship was non-linear with an inflection point of 6.8 mg/dl. On the left side of the inflection point (≤6.8 mg/dl, n = 5911 (94.56%)), the OR was 1.24 (95%CI: 1.17-1.31, P < 0.0001). On the right side of the inflection point (>6.8 mg/dl, n = 340 (5.44%)), the OR was 0.94 (95%CI:0.78-1.13, P = 0.5038). Conclusion A non-linear positive relationship was found between serum phosphate and 30-day mortality in sepsis. Serum phosphate was associated with mortality in sepsis. Our results could be used for screening out those sepsis patients with higher risk of worse outcomes.
Collapse
|
5
|
NAD + Metabolism and Interventions in Premature Renal Aging and Chronic Kidney Disease. Cells 2022; 12:cells12010021. [PMID: 36611814 PMCID: PMC9818486 DOI: 10.3390/cells12010021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Premature aging causes morphological and functional changes in the kidney, leading to chronic kidney disease (CKD). CKD is a global public health issue with far-reaching consequences, including cardio-vascular complications, increased frailty, shortened lifespan and a heightened risk of kidney failure. Dialysis or transplantation are lifesaving therapies, but they can also be debilitating. Currently, no cure is available for CKD, despite ongoing efforts to identify clinical biomarkers of premature renal aging and molecular pathways of disease progression. Kidney proximal tubular epithelial cells (PTECs) have high energy demand, and disruption of their energy homeostasis has been linked to the progression of kidney disease. Consequently, metabolic reprogramming of PTECs is gaining interest as a therapeutic tool. Preclinical and clinical evidence is emerging that NAD+ homeostasis, crucial for PTECs' oxidative metabolism, is impaired in CKD, and administration of dietary NAD+ precursors could have a prophylactic role against age-related kidney disease. This review describes the biology of NAD+ in the kidney, including its precursors and cellular roles, and discusses the importance of NAD+ homeostasis for renal health. Furthermore, we provide a comprehensive summary of preclinical and clinical studies aimed at increasing NAD+ levels in premature renal aging and CKD.
Collapse
|
6
|
Belcher SM, Guillette MP, Robb F, Rock KD. Comparative assessment of blood mercury in American alligators (Alligator mississippiensis) from Coastal North Carolina and Florida. ECOTOXICOLOGY (LONDON, ENGLAND) 2022; 31:1137-1146. [PMID: 35918620 PMCID: PMC9463099 DOI: 10.1007/s10646-022-02573-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Mercury (Hg) is a widespread and harmful persistent pollutant of aquatic ecosystems. Except for the northern most populations of American alligators (Alligator Mississippiensis) found in North Carolina, the potential adverse health impacts of Hg on ecosystems and humans consuming alligator meat have been studied for over three decades. Now that alligators are being recreationally hunted and consumed across their range, it is especially important to monitor toxic contaminant levels to best understand possible adverse impacts of exposures on alligator populations and human health. In this study, we determined blood Hg concentrations in American alligators from an urbanized site in Wilmington, NC, a nearby site at Lake Waccamaw, NC, and a site on the St Johns River in Florida. Median blood total Hg (tHg) concentrations were particularly high at Lake Waccamaw (526 ng/g, range 152-946 ng/g), resulting in median muscle concentrations (0.48 mg/kg, range 0.13-0.88 mg/kg) well above US EPA screening values for fish consumption. Median concentrations at the Wilmington site (69 ng/g, range 22-336 ng/g) were generally low, and Hg concentrations from the St Johns River site (143 ng/g, range 54-244 ng/g) were comparable to those reported in previous studies. Analysis of relationships between tHg concentrations and a panel of blood chemistry biomarkers found only modest concentration-dependent impact on biomarkers of renal function. The results of this study reveal that local environmental factors greatly impact Hg bioaccumulation in alligators, findings that reaffirm local contaminant biomonitoring in alligator populations will be critical for affective management and determination of guidelines for safe consumption of harvested alligators.
Collapse
Affiliation(s)
- Scott M Belcher
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA.
| | - Matthew P Guillette
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Frank Robb
- Environmental Education, Awareness, Research, Support & Services, Titusville, FL, USA
| | - Kylie D Rock
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| |
Collapse
|
7
|
Abstract
Eating a net acid-producing diet can produce an "acid stress" of severity proportional to the diet net acid load, as indexed by the steady-state renal net acid excretion rate. Depending on how much acid or base is ingested or produced from endogenous metabolic processes and how well our homeostatic mechanisms can buffer or eliminate the additional acids or bases, we can alter our systemic acid-base balance. With increasing age, the kidney's ability to excrete daily net acid loads declines (a condition similar to that of mild CKD), invoking increased utilization of potential base stores (eg, bone, skeletal muscle) on a daily basis to mitigate the acid accumulation, thereby contributing to development of osteoporosis, loss of muscle mass, and age-related renal insufficiency. Patients suffering from more advanced CKD often present with more severe acid stress or metabolic acidosis, as the kidney can no longer excrete the entire acid load. Alkaline diets based on fruits and vegetables may have a positive effect on long-term preservation of renal function while maintaining nutritional status. This chapter discusses the biochemistry of dietary precursors that affect acid or base production.
Collapse
Affiliation(s)
- Lynda Frassetto
- Department of Medicine, University of California San Francisco, San Francisco, CA.
| | - Thomas Remer
- Department of Nutrition and Lifestyle Sciences, University of Bonn, Bonn, Germany
| | - Tanushree Banerjee
- Department of Medicine, University of California San Francisco, San Francisco, CA
| |
Collapse
|
8
|
Stopic B, Medic-Brkic B, Savic-Vujovic K, Davidovic Z, Todorovic J, Dimkovic N. Biomarkers and Predictors of Adverse Cardiovascular Events in Different Stages of Chronic Kidney Disease. Dose Response 2022; 20:15593258221127568. [PMID: 36118679 PMCID: PMC9478703 DOI: 10.1177/15593258221127568] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chronic kidney disease (CKD) is an important factor that contributes to the
increase of all-cause morbidity and mortality in the group of non-communicable
diseases, and it is also recognized as a strong and independent risk factor that
contributes to cardiovascular disease (CVD). CVDs are a consequence of the
action of a large number of risk factors among which are traditional and
non-traditional. These risk factors have been the subject of a large number of
studies which partially explained the unfavorable cardiovascular (CV) outcome of
CKD patients. Therefore, valid studies about clinical and biohumoral predictors
are of particular importance, especially in the early stages of renal disease,
that is, in patients with creatinine clearance below
60 ml/min/1.73 m2 when preventive measures are most effective.
Among potential predictors of adverse CV outcome are biomarkers of inflammation
(Interleukin-18—IL-18), oxidative stress (ischemia-modified albumin—IMA;
superoxide dismutase—SOD), acute kidney injury (kidney injury
molecule-1—KIM-1; neutrophil gelatinase–associated
lipocalin—NGAL), and microribonucleic acids (specific microRNA-133a). In this
review, we tried to confirm the relationship between risk factors of CKD and CVD
and newer, less frequently examined biomarkers with the occurrence of incidental
CV events in renal patients.
Collapse
Affiliation(s)
- Bojan Stopic
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Branislava Medic-Brkic
- Faculty of Medicine, Department of Pharmacology, University of Belgrade, Belgrade, Serbia
| | - Katarina Savic-Vujovic
- Faculty of Medicine, Department of Pharmacology, University of Belgrade, Belgrade, Serbia
| | - Zeljko Davidovic
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Jovana Todorovic
- Faculty of Medicine, Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
| | - Nada Dimkovic
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| |
Collapse
|