High Phosphocalcic Product May Rule Out Transplants

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DENVER—A high phosphocalcic product significantly increases the risk of non-eligibility for a kidney transplant among adults with end-stage renal disease (ESRD), Canadian researchers concluded.

As phosphocalcic product is a modifiable risk factor, the investigators noted, nephrologists should monitor its level closely to prevent long-term consequences of severe vascular calcifications (VCs) and its impact on transplantation.

Samira Sadowski, MD, of Centre Hospitalier de l'Université de Montréal, and colleagues, noted that VCs are seen in about 50%-65% of patients with ESRD. VCs are thought to increase the risk of cardiovascular disease and mortality in this population, they stated. “Patients with severe pre-transplant calcifications may be denied access to transplantation because of cardiovascular risk or technical contraindications to surgery,” they noted in a poster.

Various factors have been associated with VCs, including hyperphosphatemia, a high phosphocalcic product, and secondary hyperparathyroidism. The importance of these factors in the development of VCs severe enough to deny access to renal transplantation has not been clearly delineated, the authors stated.
Dr. Sadowski's group conducted a case-control study of a 1,574 adults evaluated for a renal transplant. The researchers defined cases as patients who were denied a kidney transplant because of severe VCs; they defined controls as patients who were accepted for a kidney transplant. The evaluation date for transplant eligibility was the case index date.

The study included 83 cases and 80 controls. The phosphocalcic product was above 4 mmol2/L2 in 44% of the cases compared with 22% of controls. A phosphocalcic product above 4 mmol2/L2 was associated with a significant threefold increased risk for transplant noneligibility, after adjusting for age, dialysis duration, history of smoking, diabetes, and history of coronary artery disease.

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