Associations of phosphorus concentrations with medial arterial calcification in lower-extremity arteries and diabetic foot in people with diabetes: a retrospective cross-sectional study
Authors' conclusion
Elevated serum phosphorus levels are significantly associated with an increased risk of developing MAC and DF among diabetic people. These findings suggest that phosphorus management could be integrated into routine diagnostic processes to improve the identification and management of lower-extremity diabetic complications.
Study context
- Population
- Patients with diabetes, Department of Endocrinology, Sun Yat-Sen Memorial Hospital (2019–2023); mean age 63.9 years, 401 (57.20%) male
- Participants
- 701 patients
- Exposure
- Per one-unit increase in serum phosphorus
- Outcome
- Risk of MAC in lower-limb arteries and DF by serum phosphorus level
Methodological detailssingle-centre, multimodel-adjusted logistic regression, restricted cubic spline, threshold analysis, subgroup analyses
- Single-centre
- Multimodel-adjusted logistic regression
- Restricted cubic spline
- Threshold analysis
- Subgroup analyses
Main finding
As reported in the abstract
Medial arterial calcification (MAC) prevalence
333
47.50%
Diabetic foot (DF) prevalence
329
46.93%
MAC, OR per one-unit increase in phosphorus
OR 2.65, 95% CI 1.97-3.57
p < 0.001
DF, OR per one-unit increase in phosphorus
OR 1.54, 95% CI 1.09-2.18
p = 0.014
Observational data: associations, not effects.
Further findings
Dose-response and inflection point
- Linear risk association; inflection point for MAC
- ≈3.28 mg/dL
- Inflection point for DF (varied)
- 3.26 to 3.81 mg/dL
Diagnostic utility
- Adding phosphorus to diagnostic model for MAC and DF increased C index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) to varying degrees
Original publication
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