{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:39:47Z","timestamp":1770273587690,"version":"3.49.0"},"reference-count":37,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,10]],"date-time":"2021-11-10T00:00:00Z","timestamp":1636502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Higher serum phosphorus has detrimental health effects. Even high-normal rage sP is associated with worse outcomes. The relationship of serum phosphorus with prognostic markers in heart failure remains unclear. We investigated the association of serum phosphorus with heart failure prognostic factors and risk of mortality related to serum phosphorus. In 1029 stable heart failure patients, we investigated the distribution of markers of more advanced heart failure stage across quintiles of serum phosphorus and estimated the relative risk of mortality in comparison to reference. Higher serum phosphorus levels sP were associated with markers of a worse outcome. The best survival was observed in low-normal serum levels. The unadjusted hazard ratio for mortality increased toward higher phosphorus quintiles but not to lower levels of sP. The correction for age, sex, BMI, percent weight loss, inflammation, kidney function, and LVEF did not modify the risk profile substantially. The adjustment for NYHA, natriuretic peptides, serum sodium, and treatment characteristics broke down the risk relationship completely. A higher serum phosphorus is associated with markers of a more risky profile of heart failure. Elevated serum levels of phosphorus sP does not provide independent prognostic information beyond the strongest markers of the severity of the syndrome. The potential involvement of higher serum phosphorus as a mediator in the pathophysiology of heart failure warrants further study.<\/jats:p>","DOI":"10.3390\/nu13114004","type":"journal-article","created":{"date-parts":[[2021,11,11]],"date-time":"2021-11-11T23:04:46Z","timestamp":1636671886000},"page":"4004","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Higher Serum Phosphorus Is Not an Independent Risk Factor of Mortality in Heart Failure with Reduced Ejection Fraction"],"prefix":"10.3390","volume":"13","author":[{"given":"Partyka","family":"Robert","sequence":"first","affiliation":[{"name":"Clinical Division of Anesthesiology and Intensive Therapy of the Department of Anesthesiology, Intensive Treatment and Emergency Medicine, Medical University of Silesia, 41-800 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1500-2768","authenticated-orcid":false,"given":"Mroczek","family":"Alina","sequence":"additional","affiliation":[{"name":"Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 41-902 Bytom, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duda","family":"Sylwia","sequence":"additional","affiliation":[{"name":"Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 41-902 Bytom, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8254-2054","authenticated-orcid":false,"given":"Malinowska-Borowska","family":"Jolanta","sequence":"additional","affiliation":[{"name":"Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 41-902 Bytom, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4154-8350","authenticated-orcid":false,"given":"Buczkowska","family":"Marta","sequence":"additional","affiliation":[{"name":"Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 41-902 Bytom, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3358-6728","authenticated-orcid":false,"given":"G\u0142ogowska-Gruszka","family":"Anna","sequence":"additional","affiliation":[{"name":"Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 41-902 Bytom, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niedziela","family":"Jacek","sequence":"additional","affiliation":[{"name":"Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, 41-800 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hudzik","family":"Bartosz","sequence":"additional","affiliation":[{"name":"Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, 41-800 Zabrze, Poland"},{"name":"Department of Cardiovascular Disease Prevention, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 41-902 Bytom, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u0105sior","family":"Mariusz","sequence":"additional","affiliation":[{"name":"Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, 41-800 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rozentryt","family":"Piotr","sequence":"additional","affiliation":[{"name":"Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 41-902 Bytom, Poland"},{"name":"Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, 41-800 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1146\/annurev.med.051308.111339","article-title":"Regulation of Phosphate Homeostasis by PTH, Vitamin D, and FGF23","volume":"61","author":"Bergwitz","year":"2010","journal-title":"Annu. Rev. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3985","DOI":"10.1113\/jphysiol.2014.273979","article-title":"Regulation of serum phosphate","volume":"592","author":"Lederer","year":"2014","journal-title":"J. Physiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.amjms.2016.04.013","article-title":"Hypophosphatemia-induced Cardiomyopathy","volume":"352","author":"Ariyoshi","year":"2016","journal-title":"Am. J. Med. Sci."},{"key":"ref_4","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_5","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1056\/NEJM200005183422003","article-title":"Coronary-Artery Calcification in Young Adults with End-Stage Renal Disease Who Are Undergoing Dialysis","volume":"342","author":"Goodman","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_6","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."},{"key":"ref_7","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_8","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1161\/CIRCULATIONAHA.105.553198","article-title":"Recurrent Events Trial Investigators. 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_9","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_10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.cca.2016.07.020","article-title":"Serum phosphorus, cardiovascular and all-cause mortality in the general population: A meta-analysis","volume":"461","author":"Bai","year":"2016","journal-title":"Clin. Chim. Acta"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ehf2.12005","article-title":"Heart failure: Preventing disease and death worldwide","volume":"1","author":"Ponikowski","year":"2014","journal-title":"ESC Heart Fail."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1002\/ehf2.12046","article-title":"Clinical characteristics and management of hospitalized and ambulatory patients with heart failure\u2013results from ESC heart failure long-term registry\u2013Egyptian cohort","volume":"2","author":"Hassanein","year":"2015","journal-title":"ESC Heart Fail."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s40620-014-0075-y","article-title":"Calcium, phosphate and calcium phosphate product are markers of outcome in patients with chronic heart failure","volume":"28","author":"Cubbon","year":"2015","journal-title":"J. Nephrol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.cardfail.2012.11.008","article-title":"Serum Phosphate and Long-Term Outcome among Patients with Stable Heart Failure","volume":"19","author":"Ess","year":"2013","journal-title":"J. Card. Fail."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1111\/j.1365-2362.2011.02631.x","article-title":"Inorganic phosphate and FGF-23 predict outcome in stable systolic heart failure","volume":"42","author":"Plischke","year":"2012","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"342","DOI":"10.3109\/14017431.2011.611250","article-title":"Parameters of Mineral Metabolism predict Midterm Clinical Outcome in End-Stage Heart Failure Patients","volume":"45","author":"Zittermann","year":"2011","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.peptides.2012.08.003","article-title":"C-terminal FGF23 is a strong predictor of survival in systolic heart failure","volume":"37","author":"Gruson","year":"2012","journal-title":"Peptides"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1053\/j.ajkd.2014.03.021","article-title":"Effects of Age, Sex, and Estrogen on Serum Phosphorus: Role for Growth Hormone and Klotho?","volume":"64","author":"Sze","year":"2014","journal-title":"Am. J. Kidney Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1053\/j.ajkd.2014.12.016","article-title":"Cardiorenal Syndrome and the Role of the Bone-Mineral Axis and Anemia","volume":"66","author":"Charytan","year":"2015","journal-title":"Am. J. Kidney Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1161\/01.CIR.102.2.203","article-title":"Renal Function, Neurohormonal Activation, and Survival in Patients With Chronic Heart Failure","volume":"102","author":"Hillege","year":"2000","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1038\/nrm3031","article-title":"A structural overview of the plasma membrane Na+,K+-ATPase and H+-ATPase ion pumps","volume":"12","author":"Morth","year":"2011","journal-title":"Nat. Rev. Mol. Cell. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.jacc.2009.03.061","article-title":"Sympathetic Nervous System Activation in Human Heart Failure: Clinical Implications of an Updated Model","volume":"54","author":"Floras","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1002\/jcsm.12026","article-title":"Higher serum phosphorus is associated with catabolic\/anabolic imbalance in heart failure","volume":"6","author":"Rozentryt","year":"2015","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e003032","DOI":"10.1161\/CIRCHEARTFAILURE.116.003032","article-title":"INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profiling Identifies Ambulatory Patients at High Risk on Medical Therapy After Hospitalizations for Heart Failure","volume":"9","author":"Stewart","year":"2016","journal-title":"Circ. Heart Fail."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.ijcard.2014.09.034","article-title":"Serum phosphorus level is related to degree of clinical response to up-titration of heart failure pharmacotherapy","volume":"177","author":"Rozentryt","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1159\/000362507","article-title":"Phosphate Binding Reduces Aortic Angiotensin-Converting Enzyme and Enhances Nitric Oxide Bioactivity in Experimental Renal Insufficiency","volume":"39","author":"Vehmas","year":"2014","journal-title":"Am. J. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3562","DOI":"10.1096\/fj.09-152488","article-title":"Dietary and genetic evidence for phosphate toxicity accelerating mammalian aging","volume":"24","author":"Ohnishi","year":"2010","journal-title":"FASEB J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"F1418","DOI":"10.1152\/ajprenal.00633.2013","article-title":"Phosphate overload directly induces systemic inflammation and malnutrition as well as vascular calcification in uremia","volume":"306","author":"Yamada","year":"2014","journal-title":"Am. J. Physiol.-Ren. Physiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1016\/S0140-6736(03)12892-9","article-title":"Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: An observational study","volume":"361","author":"Anker","year":"2003","journal-title":"Lancet"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1681\/ASN.2008101106","article-title":"Dietary Phosphorus Acutely Impairs Endothelial Function","volume":"20","author":"Shuto","year":"2009","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1159\/000479010","article-title":"Elevated Phosphate Levels Trigger Autophagy-Mediated Cellular Apoptosis in H9c2 Cardiomyoblasts","volume":"8","author":"Liu","year":"2018","journal-title":"Cardiorenal Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2857","DOI":"10.1097\/01.ASN.0000141960.01035.28","article-title":"Human Vascular Smooth Muscle Cells Undergo Vesicle-Mediated Calcification in Response to Changes in Extracellular Calcium and Phosphate Concentrations: A Potential Mechanism for Accelerated Vascular Calcification in ESRD","volume":"15","author":"Reynolds","year":"2004","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1038\/ki.2013.3","article-title":"Fibroblast growth factor 23 is not associated with and does not induce arterial calcification","volume":"83","author":"Scialla","year":"2013","journal-title":"Kidney Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"672348","DOI":"10.3389\/fmed.2021.672348","article-title":"Propensity for Calcification in Serum Associates with 2-Year Cardiovascular Mortality in Ischemic Heart Failure with Reduced Ejection Fraction","volume":"8","author":"Bojic","year":"2021","journal-title":"Front Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3927","DOI":"10.1210\/jc.2008-0784","article-title":"Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography","volume":"93","author":"Pilz","year":"2008","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1093\/eurheartj\/ehq109","article-title":"Parathyroid hormone level is associated with mortality and cardiovascular events in patients undergoing coronary angiography","volume":"31","author":"Pilz","year":"2010","journal-title":"Eur. Heart J."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/11\/4004\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:28:36Z","timestamp":1760167716000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/11\/4004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,10]]},"references-count":37,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["nu13114004"],"URL":"https:\/\/doi.org\/10.3390\/nu13114004","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,10]]}}}