{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T13:46:21Z","timestamp":1791639981754,"version":"4.3.4"},"reference-count":46,"publisher":"The Endocrine Society","issue":"5","license":[{"start":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T00:00:00Z","timestamp":1711324800000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Health\u223cHolland","award":["LSHM18029"],"award-info":[{"award-number":["LSHM18029"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>Hypophosphatemia (serum phosphate &amp;lt; 0.80\u2005mmol\/L) leads to musculoskeletal complaints. The most common drugs linked to hypophosphatemia are thiazide and loop diuretics, but studies in the general population are lacking. Our aim was to study associations between diuretic use and serum phosphate in the Rotterdam Study (RS), a population-based cohort study, with replication in UK Biobank (UKBB).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Associations between thiazide and loop diuretic use and serum phosphate and odds of hypophosphatemia were analyzed with cross-sectional multivariate linear and logistic regression in participants without chronic kidney disease in the RS and UKBB. Analyses were adjusted for age, sex, and body mass index (BMI) and pooled in 3 RS cohorts with further adjustment for cohort and serum potassium, which was not available in UKBB.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Thiazide diuretics were associated with lower serum phosphate in both sexes. This association lost significance in RS females after adjustment for BMI and in males after adjustment for serum potassium. Thiazide diuretics increased odds of hypophosphatemia in females in both cohorts and in males in UKBB only. Loop diuretics were associated with lower serum phosphate in females but not males. Adjustment for BMI attenuated these associations. Associations between loop diuretics and increased odds of hypophosphatemia in females lost significance after BMI adjustment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Thiazides, but not loop diuretics, and increased BMI and decreased serum potassium should be considered as contributing factors in subjects with hypophosphatemia. Further studies are needed to replicate the findings and elucidate the potential role of hypokalemia as a mediator of this effect.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/jendso\/bvae057","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T09:14:40Z","timestamp":1711358080000},"source":"Crossref","is-referenced-by-count":1,"title":["Diuretic Use and Serum Phosphate: Rotterdam Study and UK Biobank"],"prefix":"10.1210","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7466-1472","authenticated-orcid":false,"given":"Ariadne","family":"Bosman","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Erasmus MC, University Medical Center , 3015 GD Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Campos-Obando","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Erasmus MC, University Medical Center , 3015 GD Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine E","family":"de Keyser","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Medical Center Utrecht , 3584 CX Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno H","family":"Stricker","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Erasmus MC, University Medical Center , 3015 GD Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9186-3423","authenticated-orcid":false,"given":"M Carola","family":"Zillikens","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Erasmus MC, University Medical Center , 3015 GD Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2024,3,25]]},"reference":[{"issue":"3","key":"2024040312010472100_bvae057-B1","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1038\/ncpneph0124","article-title":"Hypophosphatemia: an evidence-based approach to its clinical consequences and management","volume":"2","author":"Amanzadeh","year":"2006","journal-title":"Nat Clin Pract Nephrol"},{"issue":"3","key":"2024040312010472100_bvae057-B2","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1210\/jc.2011-1319","article-title":"Approach to the hypophosphatemic patient","volume":"97","author":"Imel","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2024040312010472100_bvae057-B3","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1016\/j.clnu.2020.09.045","article-title":"Hypophosphatemia in critically ill adults and children\u2014a systematic review","volume":"40","author":"Reintam Blaser","year":"2021","journal-title":"Clin Nutr"},{"issue":"11","key":"2024040312010472100_bvae057-B4","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1038\/s41574-018-0076-3","article-title":"Role of phosphate sensing in bone and mineral metabolism","volume":"14","author":"Chande","year":"2018","journal-title":"Nat Rev Endocrinol"},{"issue":"4","key":"2024040312010472100_bvae057-B5","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.jacc.2015.10.083","article-title":"Efficacy of low-dose chlorthalidone and hydrochlorothiazide as assessed by 24-h ambulatory blood pressure monitoring","volume":"67","author":"Pareek","year":"2016","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"2024040312010472100_bvae057-B6","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s40264-019-00888-1","article-title":"Drug-Induced hypophosphatemia: current insights","volume":"43","author":"Megapanou","year":"2020","journal-title":"Drug Saf"},{"issue":"8","key":"2024040312010472100_bvae057-B7","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/S0026-0495(71)80005-7","article-title":"Dual effect of potent diuretics on renal handling of phosphate in man","volume":"20","author":"Steele","year":"1971","journal-title":"Metab Clin Exp"},{"issue":"6","key":"2024040312010472100_bvae057-B8","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1001\/archinte.1973.00320120068006","article-title":"Excretion of phosphate and calcium. 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