Can we IMPROVE cardiovascular outcomes through phosphate lowering in CKD? Rationale and protocol for the IMpact of Phosphate Reduction On Vascular End-points in Chronic Kidney Disease (IMPROVE-CKD) study

BMJ Open
Nicole M LioufasIMPROVE-CKD Writing Committee.

Abstract

Patients with chronic kidney disease (CKD) are at heightened cardiovascular risk, which has been associated with abnormalities of bone and mineral metabolism. A deeper understanding of these abnormalities should facilitate improved treatment strategies and patient-level outcomes, but at present there are few large, randomised controlled clinical trials to guide management. Positive associations between serum phosphate and fibroblast growth factor 23 (FGF-23) and cardiovascular morbidity and mortality in both the general and CKD populations have resulted in clinical guidelines suggesting that serum phosphate be targeted towards the normal range, although few randomised and placebo-controlled studies have addressed clinical outcomes using interventions to improve phosphate control. Early preventive measures to reduce the development and progression of vascular calcification, left ventricular hypertrophy and arterial stiffness are crucial in patients with CKD. We outline the rationale and protocol for an international, multicentre, randomised parallel-group trial assessing the impact of the non-calcium-based phosphate binder, lanthanum carbonate, compared with placebo on surrogate markers of cardiovascular disease in a predialysis...Continue Reading

Citations

Jan 23, 2019·Diabetes·Radica Z AlicicKatherine R Tuttle
Jul 31, 2019·Current Opinion in Nephrology and Hypertension·Luke PickupCharles J Ferro
Sep 13, 2020·Journal of the American Society of Nephrology : JASN·Nigel D ToussaintUNKNOWN IMPROVE-CKD Trial Investigators
May 16, 2019·Journal of the American Society of Nephrology : JASN·Wing-Chi G YeungSunil V Badve
Sep 21, 2020·The Journal of Clinical Endocrinology and Metabolism·Shilpa SharmaJoachim H Ix
Jan 23, 2021·Journal of Molecular Medicine : Official Organ of the Gesellschaft Deutscher Naturforscher Und Ärzte·Philip DüsingFelix Jansen
May 30, 2020·Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation·Marguerite ConleyKatrina L Campbell
Jun 28, 2021·Lancet·Kamyar Kalantar-ZadehVlado Perkovic

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Methods Mentioned

BETA
PCR
urine collections
X-ray

Software Mentioned

ArMORR
IMPROVE
COMBINE

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