Phosphate in early chronic kidney disease: Associations with clinical outcomes and a target to reduce cardiovascular risk

• Published in: Nephrology (Carlton, Vic.) Vol. 17; no. 5; pp. 433 - 444
• Main Authors: TOUSSAINT, NIGEL D, PEDAGOGOS, EUGENIE, TAN, SVEN-JEAN, BADVE, SUNIL V, HAWLEY, CARMEL M, PERKOVIC, VLADO, ELDER, GRAHAME J
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.07.2012
• Subjects: Biomarkers - blood; Bone; Bone and Bones - metabolism; bone metabolism; Bone Remodeling; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Cardiovascular Diseases - prevention & control; cardiovascular risk; Chelating Agents - therapeutic use; chronic kidney disease (CKD); Disease Progression; Evidence-Based Medicine; Fibroblast Growth Factors - blood; Humans; Hyperphosphatemia - blood; Hyperphosphatemia - etiology; Hyperphosphatemia - mortality; Hyperphosphatemia - physiopathology; Hyperphosphatemia - therapy; Hypertrophy, Left Ventricular - blood; Hypertrophy, Left Ventricular - etiology; Intervention; Kidney; Kidney - metabolism; Kidney - physiopathology; Kidney Diseases - blood; Kidney Diseases - complications; Kidney Diseases - mortality; Kidney Diseases - physiopathology; Kidney Diseases - therapy; Minerals; Morbidity; Mortality; phosphate; Phosphates; Phosphates - blood; Phosphorus, Dietary - administration & dosage; Reviews; Risk Assessment; Risk Factors; Vascular Calcification - blood; Vascular Calcification - etiology; Vascular Stiffness
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/j.1440-1797.2012.01618.x

ABSTRACT There is an intimate association between mineral and bone disorders in chronic kidney disease (CKD) and the extensive burden of cardiovascular disease (CVD) in this population. High phosphate levels in CKD have been associated with increased all‐cause mortality and cardiovascular morbidity and mortality. Observational studies have also shown a consistent relationship between serum phosphate in the normal range and all‐cause and cardiovascular mortality, left ventricular hypertrophy (LVH) and decline in renal function. Furthermore, fibroblast growth factor‐23 (FGF‐23), a phosphaturic hormone, increases very early in the course of CKD and is strongly associated with death and CVD, including LVH and vascular calcification. Few studies have addressed outcomes using interventions to reduce serum phosphate in a randomized controlled fashion; however, strategies to address cardiovascular risk in early CKD are imperative and phosphate is a potential therapeutic target. This review outlines the epidemiological and experimental evidence highlighting the relationship between excess phosphate and adverse outcomes, and discusses clinical studies required to address this problem. This review highlights the association between mineral and bone disorders in chronic kidney disease and the extensive burden of cardiovascular disease. A systematic review on the current evidence linking phosphate metabolism and cardiovascular disease, left ventricular hypertrophy, vascular calcification and arterial compliance is presented.