| Theme |
Phosphate regulatory system and disorder in phosphate homeostasis |
| Title |
Hyperphosphatemia and mortality in dialysis and predialysis patients |
| Author |
Kentaro Nakai |
Division of Nephrology and Kidney Center, Kobe University School of Medicine |
| Author |
Hirotaka Komaba |
Division of Nephrology and Kidney Center, Kobe University School of Medicine |
| Author |
Masafumi Fukagawa |
Division of Nephrology and Metabolism, Tokai University School of Medicine |
| [ Summary ] |
Hyperphosphatemia is independently associated with all-cause and cardiovascular mortality in dialysis patients with chronic kidney disease (CKD). Furthermore, it has also been shown that high-normal serum phosphate levels are associated with cardiovascular events and mortality in predialysis patients with early stage CKD. In this context, a recent report stating that higher serum levels of FGF23 at the initiation of dialysis are associated with mortality even in patients with normophosphatemia suggests that chronic exposure to a high dietary intake, produces FGF23 levels rather than serum phosphate levels, which may be associated with high mortality rates. In addition, more aggressive treatment of hyperphosphatemia may improve clinical outcomes. However, these potentials are only based on observational studies. No interventional studies have ever examined the impact of serum phosphate reduction on survival. Further, well-designed studies are needed to determine whether treatment of hyperphosphatemia provides survival benefits for CKD patients. |