Key result
High serum phosphorus is linked to ~51% higher incident AF risk in stage 3 CKD.
Why the study?
The contribution of phosphorus and other electrolyte disturbances to AF risk in CKD remained unclear. Because phosphorus dysregulation begins in CKD stage 3, this stage offers an opportunity to assess its arrhythmogenic potential before advanced metabolic derangements develop.
Are elevated baseline serum phosphorus levels associated with an increased incidence of atrial fibrillation in adults with chronic kidney disease stage 3?
Cohort (n=21,078)
No
Are elevated baseline serum phosphorus levels associated with an increased incidence of atrial fibrillation in adults with chronic kidney disease stage 3?
In patients with stage 3 CKD, elevated serum phosphorus (>4.70 mg/dL) and hypocalcemia are independently associated with an increased risk of developing atrial fibrillation, highlighting the potential value of early mineral monitoring before advanced kidney disease develops.
Answers are grounded in this paper and cite their sources.
May warrant early mineral monitoring in stage 3 CKD; extends CKD-AF links but leaves open whether targeting phosphorus reduces risk.
Chronic kidney disease (CKD) is strongly associated with atrial fibrillation (AF), yet the contribution of phosphorus and other electrolyte disturbances to AF risk in CKD remains unclear. Phosphorus dysregulation begins early in CKD stage 3, offering an opportunity to assess its arrhythmogenic potential before advanced metabolic derangements develop in later stages. This study aimed to evaluate the association between serum phosphorus levels and the incidence of AF in patients with CKD stage 3. We conducted a retrospective cohort study of 21,078 patients with CKD stage 3 at Ramathibodi Hospital between 2010 and 2024. Baseline serum phosphorus levels were collected. The primary outcome was AF incidence. Cox proportional hazards and cubic spline models were used to evaluate associations between phosphorus and AF. Over a median follow-up of 6.2 years, 2,264 incident AF events occurred, corresponding to an incidence rate of 17.2 per 1,000 person-years. Cubic spline analysis demonstrated a nonlinear, J-shaped association, with the lowest AF risk observed at approximately 3.40 mg/dL, and a gradual increase in risk at higher phosphorus, particularly above 4.70 mg/dL, which had a 51% higher risk compared with those in the reference (HR 1.51; 95% CI 1.29–1.77; P < 0.001). Additionally, hypocalcemia was identified as an independent risk factor, whereas hypokalemia and hypomagnesemia were not. In patients with CKD stage 3, serum phosphorus levels were independently associated with an increased incidence of AF in a nonlinear pattern. These findings emphasize the potential importance of monitoring serum phosphorus in early CKD. Not applicable.
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Sutharattanapong et al. (2026) conducted a cohort in Chronic kidney disease stage 3 (n=21,078). Elevated baseline serum phosphorus (>4.70 mg/dL) vs. Low-normal baseline serum phosphorus (2.30-3.40 mg/dL) was evaluated on Incidence of atrial fibrillation (events per 1,000 person-years) (HR 1.51, 95% CI 1.29-1.77, p=<0.001). Serum phosphorus >4.70 mg/dL was associated with a 51% higher risk of incident atrial fibrillation vs 2.30–3.40 mg/dL in CKD stage 3 (aHR 1.51; 95% CI 1.29–1.77; P<0.001).
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