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Low serum phosphate is associated with ischemic stroke in hemodialysis patients

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Abstract

Background

Hemodialysis patients have a high incidence of ischemic stroke. However, the association between serum phosphate levels and ischemic stroke is controversial among hemodialysis patients. The present study is used to evaluate whether serum phosphate levels are associated with ischemic stroke among patients undergoing hemodialysis.

Methods

A total of 84 hemodialysis patients were followed up for 8 years. Data collection included chart reviews and assessments of laboratory records. The ischemic stroke diagnosis was made on the basis of history, physical examination and neuroimaging (computed tomography and/or magnetic resonance imaging) by neurologists. Cox proportional hazard regression models were used to analyze the data.

Results

During the follow-up period, 29 patients experienced ischemic stroke. According to Cox proportional hazard regression analysis, the risk of ischemic stroke decreased by 45.5% for each 1-mg/dL increase in averaged serum phosphate (HR 0.545, p = 0.011). The risk of ischemic stroke increased by 4.3% for each 1-year increase in age (HR 1.043, p = 0.018). The risk of ischemic stroke increased by 1.1% increase for each 103/μL increase in averaged blood platelet (HR 1.011, p = 0.009). The risk of ischemic stroke in patients with averaged serum phosphate < 4.5 mg/dL increased 3.40-fold more than patients with averaged serum phosphate ≥ 4.5 mg/dL (HR 3.400, p = 0.025).

Conclusions

Low serum phosphate is a risk factor for developing ischemic stroke in hemodialysis patients. The results suggest that managing serum phosphate ≥ 4.5 mg/dL among hemodialysis patients may reduce the risk of ischemic stroke.

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Funding

This study was not funded.

Author information

Author notes

  1. Tsang-Shan Chen and Chao-Hung Chen have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Tainan Sinlau Hospital, Tainan, Taiwan

    Tsang-Shan Chen

  2. Department of Internal Medicine, Tainan Sinlau Hospital, Tainan, Taiwan

    Chao-Hung Chen

  3. Department of Nephrology, Tainan Sinlau Hospital, No. 57, 1 Sec., Dongmen Rd., Tainan, Taiwan

    Chien-An Chen

  4. Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan

    Chien-An Chen & Li-Ping Chou

  5. Department of Cardiology, Tainan Sinlau Hospital, Tainan, Taiwan

    Li-Ping Chou

  6. Department of Anesthesia, Tainan Sinlau Hospital, Tainan, Taiwan

    Chi-Chu Liu

  7. Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan

    Chi-Chu Liu

Authors
  1. Tsang-Shan Chen
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  2. Chao-Hung Chen
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  3. Chien-An Chen
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Corresponding author

Correspondence to Chien-An Chen.

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Conflict of interest

The author declares that there is no competing interest.

Ethical approval

This study was approved by the Institutional Ethics Committee of Tainan Sinlau Hospital. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The informed consent of patients was obtained in accordance with the Declaration of Helsinki.

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Cite this article

Chen, TS., Chen, CH., Chen, CA. et al. Low serum phosphate is associated with ischemic stroke in hemodialysis patients. Clin Exp Nephrol 22, 1182–1187 (2018). https://doi.org/10.1007/s10157-018-1578-y

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  • DOI: https://doi.org/10.1007/s10157-018-1578-y

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