For patients with chronic kidney disease (CKD), phosphate homeostasis is important. In January 2017, published a review that "Nat Rev Nephrol.", the latest epidemiological data consistently show that the clinical outcome of hyperphosphatemia associated with worse, the increasing of phosphate concentration will bring direct toxicity.
In the past ten years, it has been recognized that phosphate homeostasis is very important in chronic kidney disease (CKD), but new ideas are emerging and are often associated with daily clinical practice.
Epidemiological data consistently indicate that hyperphosphatemia is associated with poorer clinical outcomes. In addition, strong evidence confirms that increased phosphate concentration can also lead to direct toxicity. It is worth noting that there is a physiological rhythm of serum phosphate concentration, and the physiological rhythm of the patients should be taken into account when interpreting the patients. A detailed understanding of the dietary sources of phosphate, including food additives, can limit the level of phosphate without causing protein malnutrition. This diet is often underestimated, leading to an increase in dietary phosphate exposure in both normal and CKD patients. In patients with hyperparathyroidism, the skeleton is an important source of serum phosphate, an increase that is sufficient to affect treatment.
Dietary intervention and drug therapy were effective in reducing phosphate intake and serum concentration. However, there is insufficient evidence to control serum phosphate levels to improve outcomes. Therefore, more research is needed to investigate the impact of modern diet and drug interventions on meaningful clinical endpoints.
(topic: Han Ru. Editor: Jia Zhaojuan)
The Department of pharmacy of No.3 Hospital of Peking University (by Professor Zhai suodi12 and team selection and revision, global medical information editing. )
Expert comment: in the context of the lack of clinical evidence, whether oral phosphorus binding agent can control the level of serum phosphorus in end-stage renal disease, especially in dialysis patients, is still unknown. In addition, there are many problems that are not clear, such as the timing and indications of the treatment of phosphate binder, the advantages and benefits of the use of different types of phosphate binders. )