{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T17:58:26Z","timestamp":1764784706120,"version":"build-2065373602"},"reference-count":54,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T00:00:00Z","timestamp":1632700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The goal of this study was to categorize patients with abnormal serum phosphate upon hospital admission into distinct clusters utilizing an unsupervised machine learning approach, and to assess the mortality risk associated with these clusters. Methods: We utilized the consensus clustering approach on demographic information, comorbidities, principal diagnoses, and laboratory data of hypophosphatemia (serum phosphate \u2264 2.4 mg\/dL) and hyperphosphatemia cohorts (serum phosphate \u2265 4.6 mg\/dL). The standardized mean difference was applied to determine each cluster\u2019s key features. We assessed the association of the clusters with mortality. Results: In the hypophosphatemia cohort (n = 3113), the consensus cluster analysis identified two clusters. The key features of patients in Cluster 2, compared with Cluster 1, included: older age; a higher comorbidity burden, particularly hypertension; diabetes mellitus; coronary artery disease; lower eGFR; and more acute kidney injury (AKI) at admission. Cluster 2 had a comparable hospital mortality (3.7% vs. 2.9%; p = 0.17), but a higher one-year mortality (26.8% vs. 14.0%; p &lt; 0.001), and five-year mortality (20.2% vs. 44.3%; p &lt; 0.001), compared to Cluster 1. In the hyperphosphatemia cohort (n = 7252), the analysis identified two clusters. The key features of patients in Cluster 2, compared with Cluster 1, included: older age; more primary admission for kidney disease; more history of hypertension; more end-stage kidney disease; more AKI at admission; and higher admission potassium, magnesium, and phosphate. Cluster 2 had a higher hospital (8.9% vs. 2.4%; p &lt; 0.001) one-year mortality (32.9% vs. 14.8%; p &lt; 0.001), and five-year mortality (24.5% vs. 51.1%; p &lt; 0.001), compared with Cluster 1. Conclusion: Our cluster analysis classified clinically distinct phenotypes with different mortality risks among hospitalized patients with serum phosphate derangements. Age, comorbidities, and kidney function were the key features that differentiated the phenotypes.<\/jats:p>","DOI":"10.3390\/jcm10194441","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T10:39:20Z","timestamp":1632739160000},"page":"4441","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Machine Learning Consensus Clustering Approach for Hospitalized Patients with Phosphate Derangements"],"prefix":"10.3390","volume":"10","author":[{"given":"Charat","family":"Thongprayoon","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 59005, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carissa Y.","family":"Dumancas","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 59005, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9389-073X","authenticated-orcid":false,"given":"Voravech","family":"Nissaisorakarn","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mira T.","family":"Keddis","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea G.","family":"Kattah","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 59005, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6010-0033","authenticated-orcid":false,"given":"Pattharawin","family":"Pattharanitima","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7633-4029","authenticated-orcid":false,"given":"Tananchai","family":"Petnak","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1631-8238","authenticated-orcid":false,"given":"Saraschandra","family":"Vallabhajosyula","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vesna D.","family":"Garovic","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 59005, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1814-7003","authenticated-orcid":false,"given":"Michael A.","family":"Mao","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John J.","family":"Dillon","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 59005, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen B.","family":"Erickson","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 59005, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9954-9711","authenticated-orcid":false,"given":"Wisit","family":"Cheungpasitporn","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 59005, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.2215\/CJN.09750913","article-title":"Renal control of calcium, phosphate, and magnesium homeostasis","volume":"10","author":"Blaine","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"230","DOI":"10.23736\/S0031-0808.17.03331-6","article-title":"Cardiovascular consequences of hypophosphatemia","volume":"59","author":"Ariyoshi","year":"2017","journal-title":"Panminerva Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1161\/CIRCULATIONAHA.105.553198","article-title":"Relation between serum phosphate level and cardiovascular event rate in people with coronary disease","volume":"112","author":"Tonelli","year":"2005","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00005792-200001000-00001","article-title":"Severe hypophosphatemia. Pathophysiologic implications, clinical presentations, and treatment","volume":"79","author":"Subramanian","year":"2000","journal-title":"Medicine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.amjmed.2012.08.018","article-title":"Phosphorus and risk of renal failure in subjects with normal renal function","volume":"126","author":"Sim","year":"2013","journal-title":"Am. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1146\/annurev-physiol-030212-183748","article-title":"Phosphate transporters and their function","volume":"75","author":"Biber","year":"2013","journal-title":"Annu. Rev. Physiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Cheungpasitporn, W., Hansrivijit, P., Thirunavukkarasu, S., Chewcharat, A., Medaura, J., Mao, M.A., and Kashani, K.B. (2020). Impact of serum phosphate changes on in-hospital mortality. BMC Nephrol., 21.","DOI":"10.1186\/s12882-020-02090-3"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Moon, H., Chin, H.J., Na, K.Y., Joo, K.W., Kim, Y.S., Kim, S., and Han, S.S. (2019). Hyperphosphatemia and risks of acute kidney injury, end-stage renal disease, and mortality in hospitalized patients. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1556-y"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s40620-017-0442-6","article-title":"Admission hyperphosphatemia increases the risk of acute kidney injury in hospitalized patients","volume":"31","author":"Thongprayoon","year":"2018","journal-title":"J. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"652941","DOI":"10.3389\/fneur.2021.652941","article-title":"Serum Phosphate and 1-Year Outcome in Patients With Acute Ischemic Stroke and Transient Ischemic Attack","volume":"12","author":"Zhang","year":"2021","journal-title":"Front. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Haider, D.G., Lindner, G., Wolzt, M., Ahmad, S.S., Sauter, T., Leichtle, A.B., Fiedler, G.M., Fuhrmann, V., and Exadaktylos, A.K. (2015). Hyperphosphatemia Is an Independent Risk Factor for Mortality in Critically Ill Patients: Results from a Cross-Sectional Study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0133426"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1136\/jcp.2007.054940","article-title":"Hypophosphataemia at a large academic hospital in South Africa","volume":"61","author":"Hoffmann","year":"2008","journal-title":"J. Clin. Pathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e13461","DOI":"10.1111\/ijcp.13461","article-title":"Admission serum phosphate levels and the risk of respiratory failure","volume":"74","author":"Thongprayoon","year":"2020","journal-title":"Int. J. Clin. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Al Harbi, S.A., Al-Dorzi, H.M., Al Meshari, A.M., Tamim, H., Abdukahil, S.A.I., Sadat, M., and Arabi, Y. (2021). Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock. BMC Pharmacol. Toxicol., 22.","DOI":"10.1186\/s40360-021-00487-w"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Cheungpasitporn, W., Chewcharat, A., Petnak, T., Mao, M.A., Srivali, N., Bathini, T., Vallabhajosyula, S., Qureshi, F., and Kashani, K. (2020). Hospital-acquired serum phosphate derangements and their associated in-hospital mortality. Postgrad. Med. J., 138872.","DOI":"10.3390\/medicines7070038"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1080\/21548331.2018.1483172","article-title":"Admission serum phosphate levels predict hospital mortality","volume":"46","author":"Cheungpasitporn","year":"2018","journal-title":"Hosp. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/j.amjmed.2005.02.014","article-title":"Hypophosphatemia: An update on its etiology and treatment","volume":"118","author":"Gaasbeek","year":"2005","journal-title":"Am. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Fr\u00f6hlich, H., Balling, R., Beerenwinkel, N., Kohlbacher, O., Kumar, S., Lengauer, T., Maathuis, M.H., Moreau, Y., Murphy, S.A., and Przytycka, T.M. (2018). From hype to reality: Data science enabling personalized medicine. BMC Med., 16.","DOI":"10.1186\/s12916-018-1122-7"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.pbiomolbio.2019.11.012","article-title":"Supervised and unsupervised algorithms for bioinformatics and data science","volume":"151","author":"Sohail","year":"2020","journal-title":"Prog. Biophys. Mol. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1111\/joim.12822","article-title":"eDoctor: Machine learning and the future of medicine","volume":"284","author":"Handelman","year":"2018","journal-title":"J. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Vaitla, P., Nissaisorakarn, V., Mao, M.A., Genovez, J.L.Z., Kattah, A.G., Pattharanitima, P., Vallabhajosyula, S., Keddis, M.T., and Qureshi, F. (2021). Clinically Distinct Subtypes of Acute Kidney Injury on Hospital Admission Identified by Machine Learning Consensus Clustering. Med Sci., 9.","DOI":"10.3390\/medsci9040060"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1139\/gen-2020-0131","article-title":"Machine learning for precision medicine","volume":"64","author":"MacEachern","year":"2021","journal-title":"Genome"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1007\/s41666-018-0029-6","article-title":"Nearest Consensus Clustering Classification to Identify Subclasses and Predict Disease","volume":"2","author":"Alyousef","year":"2018","journal-title":"J. Healthc. Inform. Res."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Nissaisorakarn, V., Pattharanitima, P., Mao, M.A., Kattah, A.G., Keddis, M.T., Dumancas, C.Y., Vallabhajosyula, S., Petnak, T., and Erickson, S.B. (2021). Subtyping Hyperchloremia among Hospitalized Patients by Machine Learning Consensus Clustering. Medicina, 57.","DOI":"10.3390\/medicina57090903"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Hansrivijit, P., Mao, M.A., Vaitla, P.K., Kattah, A.G., Pattharanitima, P., Vallabhajosyula, S., Nissaisorakarn, V., Petnak, T., and Keddis, M.T. (2021). Machine Learning Consensus Clustering of Hospitalized Patients with Admission Hyponatremia. Diseases, 9.","DOI":"10.3390\/diseases9030054"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1681\/ASN.2020030239","article-title":"Subtyping CKD Patients by Consensus Clustering: The Chronic Renal Insufficiency Cohort (CRIC) Study","volume":"32","author":"Zheng","year":"2021","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Kattah, A.G., Mao, M.A., Keddis, M.T., Pattharanitima, P., Vallabhajosyula, S., Nissaisorakarn, V., Erickson, S.B., Dillon, J.J., and Garovic, V.D. (2021). Distinct Phenotypes of Hospitalized Patients with Hyperkalemia by Machine Learning Consensus Clustering and Associated Mortality Risks. Qjm.","DOI":"10.1093\/qjmed\/hcab194"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1023\/A:1023949509487","article-title":"Consensus clustering: A resampling-based method for class discovery and visualization of gene expression microarray data","volume":"52","author":"Monti","year":"2003","journal-title":"Mach. Learn."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"6207","DOI":"10.1038\/srep06207","article-title":"Critical limitations of consensus clustering in class discovery","volume":"4","author":"Michailidis","year":"2014","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1093\/bioinformatics\/btq170","article-title":"ConsensusClusterPlus: A class discovery tool with confidence assessments and item tracking","volume":"26","author":"Wilkerson","year":"2010","journal-title":"Bioinformatics"},{"key":"ref_31","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."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1111\/j.1742-1241.1997.tb11534.x","article-title":"Mechanisms of hypophosphataemia in alcoholic patients","volume":"51","author":"Elisaf","year":"1997","journal-title":"Int. J. Clin. Pract."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"536-e9","DOI":"10.1016\/j.jcrc.2012.10.011","article-title":"Hypophosphatemia in critically ill patients","volume":"28","author":"Suzuki","year":"2013","journal-title":"J. Crit. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s10741-017-9615-6","article-title":"Phosphate imbalance in patients with heart failure","volume":"22","author":"Christopoulou","year":"2017","journal-title":"Heart Fail. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.ejcts.2004.03.004","article-title":"Hypophosphatemia following open heart surgery: Incidence and consequences","volume":"26","author":"Cohen","year":"2004","journal-title":"Eur. J. Cardio-Thorac. Surg. Off. J. Eur. Assoc. Cardio-Thorac. Surg."},{"key":"ref_36","first-page":"67","article-title":"Severe hypophosphatemia in sepsis as a mortality predictor","volume":"36","author":"Shor","year":"2006","journal-title":"Ann. Clin. Lab. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1007\/BF01700966","article-title":"High incidence of hypophosphatemia in surgical intensive care patients: Efficacy of phosphorus therapy on myocardial function","volume":"21","author":"Zazzo","year":"1995","journal-title":"Intensive Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1001\/archinte.1982.00340160097021","article-title":"Phosphate therapy in diabetic ketoacidosis","volume":"142","author":"Wilson","year":"1982","journal-title":"Arch. Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1378\/chest.83.3.504","article-title":"Respiratory illness and hypophosphatemia","volume":"83","author":"Fisher","year":"1983","journal-title":"Chest"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1136\/thx.41.8.635","article-title":"Legionnaires\u2019 disease: A review of 79 community acquired cases in Nottingham","volume":"41","author":"Woodhead","year":"1986","journal-title":"Thorax"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1378\/chest.111.3.595","article-title":"Laboratory abnormalities in patients with bacterial pneumonia","volume":"111","author":"Sankaran","year":"1997","journal-title":"Chest"},{"key":"ref_42","first-page":"225","article-title":"Serum phosphate in acute myocardial infarction","volume":"44","author":"Vaidyanathan","year":"2000","journal-title":"Indian J. Physiol. Pharmacol."},{"key":"ref_43","first-page":"248","article-title":"Serum phosphorus levels predict clinical outcome in fulminant hepatic failure","volume":"9","author":"Chung","year":"2003","journal-title":"Liver Transplant. Off. Publ. Am. Assoc. Study Liver Dis. Int. Liver Transplant. Soc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1038\/ki.2008.130","article-title":"Hyperphosphatemia of chronic kidney disease","volume":"74","author":"Hruska","year":"2008","journal-title":"Kidney Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1681\/ASN.2004070602","article-title":"Serum phosphate levels and mortality risk among people with chronic kidney disease","volume":"16","author":"Kestenbaum","year":"2005","journal-title":"J. Am. Soc. Nephrol. JASN"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/S0272-6386(97)90015-9","article-title":"Severe hyperphosphatemia following phosphate administration for bowel preparation in patients with renal failure: Two cases and a review of the literature","volume":"29","author":"Fine","year":"1997","journal-title":"Am. J. Kidney Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.accpm.2015.05.001","article-title":"Acute hyperphosphataemia after a sodium phosphate-based bowel preparation in a 76-year-old woman","volume":"34","author":"Bataille","year":"2015","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_48","first-page":"61","article-title":"Phosphate induced crystal acute kidney injury\u2014An under-recognized cause of acute kidney injury potentially leading to chronic kidney disease: Case report and review of the literature","volume":"6","author":"Lochy","year":"2013","journal-title":"Int. J. Nephrol. Renov. Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1001\/archinte.163.7.803","article-title":"Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients","volume":"163","author":"Beloosesky","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Pereira, M.B., Zanetta, D.M., and Abdulkader, R.C. (2012). The real importance of pre-existing comorbidities on long-term mortality after acute kidney injury. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0047746"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1681\/ASN.2008020141","article-title":"Serum phosphorus levels associate with coronary atherosclerosis in young adults","volume":"20","author":"Foley","year":"2009","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1001\/archinte.167.9.879","article-title":"Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community","volume":"167","author":"Dhingra","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.1681\/ASN.2004040275","article-title":"Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: The USRDS waves 1, 3, and 4 study","volume":"16","author":"Slinin","year":"2005","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1097\/01.ASN.0000133041.27682.A2","article-title":"Mineral metabolism, mortality, and morbidity in maintenance hemodialysis","volume":"15","author":"Block","year":"2004","journal-title":"J. Am. Soc. Nephrol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/19\/4441\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:05:52Z","timestamp":1760166352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/19\/4441"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,27]]},"references-count":54,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["jcm10194441"],"URL":"https:\/\/doi.org\/10.3390\/jcm10194441","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2021,9,27]]}}}