Low serum phosphate is associated with ischemic stroke in hemodialysis patients

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 10(3)/mu L 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.