Phosphate balance during dialysis and after kidney transplantation in patients with chronic kidney disease

Abstract

Purpose of reviewIn patients with chronic kidney disease (CKD), hyperphosphatemia is associated with several adverse outcomes, including bone fragility and progression of kidney and cardiovascular disease. However, there is a knowledge gap regarding phosphate balance in CKD. This review explores its current state, depending on the stage of CKD, dialysis modalities, and the influence of kidney transplantation.Recent findingsAdequate phosphate control is one of the goals of treatment for CKD-mineral and bone disorder. However, ongoing studies are challenging the benefits of phosphate-lowering treatment. Nevertheless, the current therapy is based on dietary restriction, phosphate binders, and optimal removal by dialysis. In the face of limited adherence, due to the high pill burden, adjuvant options are under investigation. The recent discovery that intestinal absorption of phosphate is mostly paracellular when the intraluminal concentration is adequate might help explain why phosphate is still well absorbed in CKD, despite the lower levels of calcitriol.SummaryFuture studies could confirm the benefits of phosphate control. Greater understanding of the complex distribution of phosphate among the body compartments will help us define a better therapeutic strategy in patients with CKD.

Effects of EOS789, a novel pan-phosphate transporter inhibitor, on phosphate metabolism : Comparison with a conventional phosphate binder

“…Furthermore, Pi binders account for a large proportion of the daily pill burden of patients requiring dialysis. The pill burden and adverse effects associated with Pi binders often contribute to poor medication adherence (2)(3)(4)(5)(6)(7). Accordingly, there is a need for the development of novel small molecular compounds for the treatment of hyperphosphatemia, such as Pi transport inhibitors.…”

Factors Associated with Intradialytic Phosphate Removal in Hemodialysis Patients before and after Parathyroidectomy

“…1 Although phosphate removal during hemodialysis (HD) is a cornerstone of hyperparathyroidism treatment, we still do not know all factors that influence it. 2 We hypothesized that bone remodeling could modulate intradialytic phosphate balance and analyzed data from ten HD patients who were submitted to parathyroidectomy, who were previously included in a prospective study that examined the impact of bone turnover on calcium mass transfer during HD. 3 Their mean age was 48.1±11.0 years, and the mean dialysis vintage was 57.6±16.8 months.…”