Hyperphosphatemia and Sudden Death in Hemodialysis Patients: A Silent Threat in Kidney Disease.

Hyperphosphatemia and Sudden Death in Hemodialysis Patients: A Silent Threat in Kidney Disease. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hyperphosphatemia and Sudden Death in Hemodialysis Patients: A Silent Threat in Kidney Disease. FarzanaRasheed Narejo, Dr. Tabassum Elahi Elahi, Dr. Rukhsana Ayaz Ayaz Ahmed, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6907464/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Sudden death (SD) is a leading cause of mortality among hemodialysis patients. While hyperphosphatemia is a significant risk factor for cardiovascular and overall mortality, There is insufficient research examining the link between serum phosphate levels and the risk of sudden death. Aim: This study seeks to enhance the understanding of the relationship between serum phosphate levels and the risk of sudden death in patients receiving hemodialysis. Method: A prospective study was conducted at the renal division of the Sindh Institute of Urology and Transplantation (SIUT) in Karachi, Pakistan, involving patients with end-stage kidney disease (ESKD) of any etiology undergoing maintenance hemodialysis via permanent access. Participants who experienced cardiac symptoms and unexpectedly died of natural causes within 1 to 24 hours after the onset of symptoms during hemodialysis, without any prior fatal condition, were included. These patients were categorized into two groups based on their serum phosphate levels measured closest to their sudden death. Results: The study enrolled 175 patients who experienced cardiac symptoms, with a mean age of 44.23±14.87 years and a slight male predominance (53.1% male vs. 46.9% female). Both groups had an equal prevalence of hypertension, while more patients in Group 1 had diabetes (25.5% vs. 22.07%) and cardiovascular disease (25.5% vs. 25.97%). The mean duration of hemodialysis was similar between the groups. A significant relationship between phosphate levels and sudden death was observed (P=0.02), and Kaplan–Meier curves indicated that patients with higher baseline serum phosphate levels had a greater probability of experiencing sudden death (log-rank p=0.037). Elevated alkaline phosphatase (ALP) levels alongside hyperphosphatemia were significantly associated with an increased risk of total mortality (P=0.002). Conclusion: Hyperphosphatemia is independently linked to a higher risk of sudden death in patients undergoing hemodialysis. Sudden death (SD) Hyperphosphatemia Cardiovascular Disease (CVD) end-stage kidney disease (ESKD) Hemodialysis Full Text Additional Declarations No competing interests reported. Supplementary Files SCDtable1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6907464","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":473186531,"identity":"6cafdcb6-1cc6-4175-8de5-f1732f7c7795","order_by":0,"name":"FarzanaRasheed Narejo","email":"","orcid":"","institution":"Sindh Insitute of Urology and Transplanatation, Karachi, Sindh, PakistanN","correspondingAuthor":false,"prefix":"","firstName":"FarzanaRasheed","middleName":"","lastName":"Narejo","suffix":""},{"id":473186532,"identity":"9d8f95c8-7023-4e16-984a-9b64b7607eb5","order_by":1,"name":"Dr. Tabassum Elahi 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(ESKD), Hemodialysis","lastPublishedDoi":"10.21203/rs.3.rs-6907464/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6907464/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e\u0026nbsp;Sudden death (SD) is a leading cause of mortality among hemodialysis patients. While hyperphosphatemia is a significant risk factor for cardiovascular and overall mortality, There is insufficient research examining the link between serum phosphate levels and the risk of sudden death.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e\u0026nbsp;This study seeks to enhance the understanding of the relationship between serum phosphate levels and the risk of sudden death in patients receiving hemodialysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u0026nbsp;A prospective study was conducted at the renal division of the Sindh Institute of Urology and Transplantation (SIUT) in Karachi, Pakistan, involving patients with end-stage kidney disease (ESKD) of any etiology undergoing maintenance hemodialysis via permanent access. Participants who experienced cardiac symptoms and unexpectedly died of natural causes within 1 to 24 hours after the onset of symptoms during hemodialysis, without any prior fatal condition, were included. These patients were categorized into two groups based on their serum phosphate levels measured closest to their sudden death.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u0026nbsp;The study enrolled 175 patients who experienced cardiac symptoms, with a mean age of 44.23±14.87 years and a slight male predominance (53.1% male vs. 46.9% female). Both groups had an equal prevalence of hypertension, while more patients in Group 1 had diabetes (25.5% vs. 22.07%) and cardiovascular disease (25.5% vs. 25.97%). The mean duration of hemodialysis was similar between the groups. 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