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[Strategies aiming to control hyperphosphatemia in chronic kidney disease].
Nephrol Ther. 2017 Apr; 13 Suppl 1:S95-S101.NT

Abstract

Chronic kidney disease is known to be associated with phosphate retention. The mechanisms are complex and the early increase in serum phosphate levels in chronic kidney disease is not strictly related to the dietary phosphate load or to the degree of phosphate retention. It also implicates the activity of intestinal sodium-phosphate cotransporters, the degree of bone turnover and the retention and/or phosphate release from the skeleton, and the feedback mechanisms regulating the phosphaturia. Indeed, the increase in serum phosphate levels is only a reflection of underlying complex mechanisms, and many important factors play a role including parathyroid hormone, vitamin D, fibroblast growth factor 23 (FGF23), and others. Hyperphosphatemia increases the risk of cardiovascular morbidity and mortality in chronic kidney disease as well as in subjects with normal renal function. Oral phosphate binders are prescribed in patients with chronic kidney disease and in those treated by dialysis, to prevent intestinal absorption of dietary phosphate and reduce serum phosphate. In prospective observational studies, they have been shown to decrease all-cause and cardiovascular mortality risk. However, different problems have been associated with currently available phosphate binders including the induction of a positive calcium balance and impaired outcomes with calcium-based phosphate binders or increased costs with non-calcium-based phosphate binders. Iron-based phosphate binders represent a new class of phosphate binders. The aim of this article is to provide an update review of the pathophysiological mechanisms leading and maintaining elevated serum phosphate levels in patients with chronic kidney disease and patients in dialysis, and the educational, nutritional, and therapeutic strategies that can be undertaken to control the hyperphosphatemia.

Authors+Show Affiliations

Service de néphrologie-dialyse, Ramsay-Générale de santé, clinique du Landy, 21-23, rue du Landy, 93400 Saint-Ouen, France; Service des explorations fonctionnelles, hôpital Necker-Enfants-Malades, rue de Sèvres, 75015 Paris, France. Electronic address: urena.pablo@wanadoo.fr.

Pub Type(s)

Journal Article
Review

Language

fre

PubMed ID

28577750

Citation

Ureña Torres, Pablo Antonio. "[Strategies Aiming to Control Hyperphosphatemia in Chronic Kidney Disease]." Nephrologie & Therapeutique, vol. 13 Suppl 1, 2017, pp. S95-S101.
Ureña Torres PA. [Strategies aiming to control hyperphosphatemia in chronic kidney disease]. Nephrol Ther. 2017;13 Suppl 1:S95-S101.
Ureña Torres, P. A. (2017). [Strategies aiming to control hyperphosphatemia in chronic kidney disease]. Nephrologie & Therapeutique, 13 Suppl 1, S95-S101. https://doi.org/10.1016/j.nephro.2017.01.002
Ureña Torres PA. [Strategies Aiming to Control Hyperphosphatemia in Chronic Kidney Disease]. Nephrol Ther. 2017;13 Suppl 1:S95-S101. PubMed PMID: 28577750.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Strategies aiming to control hyperphosphatemia in chronic kidney disease]. A1 - Ureña Torres,Pablo Antonio, PY - 2016/12/14/received PY - 2017/01/09/revised PY - 2017/01/17/accepted PY - 2017/6/5/entrez PY - 2017/6/5/pubmed PY - 2018/5/8/medline KW - Calcium KW - Chronic kidney disease KW - Chélateurs de phosphate KW - Dialyse KW - Dialysis KW - FGF23 KW - Insuffisance rénale chronique KW - PTH KW - Phosphate KW - Phosphate binders SP - S95 EP - S101 JF - Nephrologie & therapeutique JO - Nephrol Ther VL - 13 Suppl 1 N2 - Chronic kidney disease is known to be associated with phosphate retention. The mechanisms are complex and the early increase in serum phosphate levels in chronic kidney disease is not strictly related to the dietary phosphate load or to the degree of phosphate retention. It also implicates the activity of intestinal sodium-phosphate cotransporters, the degree of bone turnover and the retention and/or phosphate release from the skeleton, and the feedback mechanisms regulating the phosphaturia. Indeed, the increase in serum phosphate levels is only a reflection of underlying complex mechanisms, and many important factors play a role including parathyroid hormone, vitamin D, fibroblast growth factor 23 (FGF23), and others. Hyperphosphatemia increases the risk of cardiovascular morbidity and mortality in chronic kidney disease as well as in subjects with normal renal function. Oral phosphate binders are prescribed in patients with chronic kidney disease and in those treated by dialysis, to prevent intestinal absorption of dietary phosphate and reduce serum phosphate. In prospective observational studies, they have been shown to decrease all-cause and cardiovascular mortality risk. However, different problems have been associated with currently available phosphate binders including the induction of a positive calcium balance and impaired outcomes with calcium-based phosphate binders or increased costs with non-calcium-based phosphate binders. Iron-based phosphate binders represent a new class of phosphate binders. The aim of this article is to provide an update review of the pathophysiological mechanisms leading and maintaining elevated serum phosphate levels in patients with chronic kidney disease and patients in dialysis, and the educational, nutritional, and therapeutic strategies that can be undertaken to control the hyperphosphatemia. SN - 1872-9177 UR - https://www.unboundmedicine.com/medline/citation/28577750/[Strategies_aiming_to_control_hyperphosphatemia_in_chronic_kidney_disease]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1769-7255(17)30025-1 DB - PRIME DP - Unbound Medicine ER -