The role of phosphate in kidney disease

Marc G Vervloet, Siren Sezer, Ziad A Massy, Lina Johansson, Mario Cozzolino, Denis Fouque, ERA–EDTA Working Group on Chronic Kidney Disease–Mineral and Bone Disorders and the European Renal Nutrition Working Group

Research output: Contribution to journalArticleProfessional

Abstract

The importance of phosphate homeostasis in chronic kidney disease (CKD) has been recognized for decades, but novel insights - which are frequently relevant to everyday clinical practice - continue to emerge. Epidemiological data consistently indicate an association between hyperphosphataemia and poor clinical outcomes. Moreover, compelling evidence suggests direct toxicity of increased phosphate concentrations. Importantly, serum phosphate concentration has a circadian rhythm that must be considered when interpreting patient phosphate levels. Detailed understanding of dietary sources of phosphate, including food additives, can enable phosphate restriction without risking protein malnutrition. Dietary counselling provides an often underestimated opportunity to target the increasing exposure to dietary phosphate of both the general population and patients with CKD. In patients with secondary hyperparathyroidism, bone can be an important source of serum phosphate, and adequate appreciation of this fact should impact treatment. Dietary and pharmotherapeutic interventions are efficacious strategies to lower phosphate intake and serum concentration. However, strong evidence that targeting serum phosphate improves patient outcomes is currently lacking. Future studies are, therefore, required to investigate the effects of modern dietary and pharmacological interventions on clinically meaningful end points.

Original languageEnglish
Pages (from-to)27-38
Number of pages12
JournalNature Reviews Nephrology
Volume13
Issue number1
DOIs
Publication statusPublished - Jan 2017

Cite this

Vervloet, M. G., Sezer, S., Massy, Z. A., Johansson, L., Cozzolino, M., Fouque, D., & ERA–EDTA Working Group on Chronic Kidney Disease–Mineral and Bone Disorders and the European Renal Nutrition Working Group (2017). The role of phosphate in kidney disease. Nature Reviews Nephrology, 13(1), 27-38. https://doi.org/10.1038/nrneph.2016.164