Biomarkers · Electrolytes & Minerals

Serum Phosphate

Lower values go with lower risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 9% higher risk of death. We found the same pattern in NHANES

Serum Phosphate and risk of death

NHANES, our fit with 95% CIPublished curve

Published curve higher than the NHANES fitNHANES fit higher

Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.

Risk of death per SD (NHANES)1.09×95% CI 1.06–1.12 · 43,810 adults, 5,903 deaths

Published risk of death1.27×per 1 mg/dL higher serum phosphate (age-, race-, sex-adjusted) (95% CI 1.02–1.58) · CARE trial participants with prior myocardial infarction (post hoc analysis), randomized to pravastatin or placebo

Value of the measurement+0.005gain in concordance within age bands; rank 52 of 56 · all tests

Serum Phosphate by age and sex

Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.

The percentiles as a table

Each row is one sex and age band: the values below which 5%, 25%, 50%, 75% and 95% of people fall (mg/dL), from the survey named in the row. Not a reference range or a target.
Sex	Age	5th	25th	Median	75th	95th	n	Cycle / source
All	20-39	2.80	3.30	3.60	3.90	4.50	1,429	NHANES 2017-2018
All	40-59	2.70	3.20	3.50	3.90	4.40	1,548	NHANES 2017-2018
All	60+	2.70	3.20	3.60	3.90	4.40	1,890	NHANES 2017-2018
All	all	2.80	3.20	3.60	3.90	4.50	4,867	NHANES 2017-2018
Men	20-39	2.72	3.30	3.60	3.90	4.60	684	NHANES 2017-2018
Men	40-59	2.60	3.10	3.40	3.80	4.31	723	NHANES 2017-2018
Men	60+	2.50	3.10	3.40	3.80	4.20	958	NHANES 2017-2018
Men	all	2.70	3.20	3.50	3.80	4.40	2,365	NHANES 2017-2018
Women	20-39	2.80	3.30	3.60	4.00	4.40	745	NHANES 2017-2018
Women	40-59	2.80	3.30	3.60	3.90	4.50	825	NHANES 2017-2018
Women	60+	2.90	3.40	3.70	4.00	4.50	932	NHANES 2017-2018
Women	all	2.80	3.30	3.60	4.00	4.50	2,502	NHANES 2017-2018

What studies found when this marker was changed

They describe what happened in those study groups, not a recommendation. See all catalogued interventions.

Measured changes in Serum Phosphate, study by study

3 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Intervention	Reported effect	Evidence	Source
clinical	Intensified dialytic phosphate clearance (short daily / nocturnal haemodialysis) in ESRD	In the FHN trial, short daily and nocturnal haemodialysis lowered serum phosphorus by 0.6 and 1.6 mg/dL vs 3 sessions/week	review	Copland M, et al. Intensive Hemodialysis, Mineral and Bone Disorder, and…
diet	Education to avoid phosphorus-containing food additives in hemodialysis patients	Decline in serum phosphorus 0.6 mg/dL larger vs control after 3 months (95% CI -1.0 to -0.1 mg/dL)	RCT	Sullivan C, et al. JAMA. 2009;301:629-635.
pharmacologic	Non-calcium phosphate binder (Sevelamer carbonate)	Serum phosphorus fell -2.14 ± 1.98 mg/dL with sevelamer carbonate vs -0.19 ± 1.76 mg/dL with placebo over 8 weeks in haemodialysis	RCT	Chen N, et al. Sevelamer carbonate lowers serum phosphorus effectively in…

Things that worsen it

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Condition or exposure	Reported effect	Evidence	Source
clinical	Advanced renal failure with loss of phosphaturic response	Serum phosphorus remained normal until eGFR fell below 40 ml/min, becoming abnormal in advanced CKD (effect size not reported)	cross-sectional	Levin A, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and…
diet	High intake of processed and fast foods with inorganic phosphate additives (advanced CKD)	Inorganic phosphate additives are effectively absorbed and can measurably elevate serum phosphate in advanced CKD (effect size not reported)	review	Ritz E, et al. Dtsch Arztebl Int. 2012;109:49-55.

Sources

Risk curve: Tonelli M 2005 (PMID 16246962): all-cause HR 1.27 (1.02-1.58) per 1 mg/dL higher serum phosphate (age-, race-, sex-adjusted); >=3.5 vs <3.5 mg/dL fully adjusted HR 1.27 (1.02-1.59). Scaled to US values (NHANES).
Tonelli M, et al. Relation between serum phosphate levels and cardiovascular events in people with and without chronic kidney disease. Circulation. 2005;112(17):2627-2633.
NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.

Map Serum Phosphate against another biomarker.

Map Serum Phosphate against another marker