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Kerstin Amann, Marie-Luise Gross, Gérard M. London, Eberhard Ritz, Hyperphosphataemia—a silent killer of patients with renal failure?, Nephrology Dialysis Transplantation, Volume 14, Issue 9, September 1999, Pages 2085–2087, https://doi.org/10.1093/ndt/14.9.2085
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Introduction
For decades, it has been known that patients with end-stage renal failure have an excessive coronary and cardiac risk. There is also widespread consensus that coronary atherosclerosis and its complications are not fully explained by classical risk factors, e.g. dyslipidaemia, elevated homocysteine concentrations, hypertension, insulin resistance, high fibrinogen etc.
Studies on uraemia spring many surprises. In an early investigation, the paradoxical finding had been made [1] that high cholesterol concentrations are predictive of better survival. This observation subsequently has been confirmed [2] and the paradox is presumably explained by the fact that high cholesterol is a surrogate marker for adequate nutrition. Conversely, malnutrition turned out to be highly predictive of death including cardiac death [3].
Block et al. [4] sprang another surprise on the nephrological community when they found that hyperphosphataemia predicted reduced survival. This was accounted for by an excess of cardiac death. This observation has been confirmed and extended recently [5].
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