Phosphate Metabolism in CKD Stages 3–5: Dietary and Pharmacological Control
When compared to the available information for patients on dialysis (CKD stage 5D), data on the epidemiology and appropriate treatment of calcium and phosphate metabolism in the predialysis stages of chronic kidney disease (CKD) are quite limited. Perceptible derangements of calcium and phosphate le...
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| Format: | Article |
| Language: | English |
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Wiley
2011-01-01
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| Series: | International Journal of Nephrology |
| Online Access: | http://dx.doi.org/10.4061/2011/970245 |
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| author | Markus Ketteler |
| author_facet | Markus Ketteler |
| author_sort | Markus Ketteler |
| collection | DOAJ |
| description | When compared to the available information for patients on dialysis (CKD stage 5D), data on the epidemiology and appropriate treatment of calcium and phosphate metabolism in the predialysis stages of chronic kidney disease (CKD) are quite limited. Perceptible derangements of calcium and phosphate levels start to become apparent when GFR falls below 30 mL/min in some, but not all, patients. However, hyperphosphatemia may be a significant morbidity and mortality risk predictor in predialysis CKD stages. The RIND study, evaluating progression of coronary artery calcification in incident hemodialysis patients, indirectly demonstrated that vascular calcification processes start to manifest in CKD patients prior to the dialysis stage, which may be closely linked to early and invisible derangements in calcium and phosphate homeostasis. Novel insights into the pathophysiology of calcium and phosphate handling such as the discovery of FGF23 and other phosphatonins suggest that a more complex assessment of phosphate balance is warranted, possibly including measurements of fractional phosphate excretion and phosphatonin levels in order to appropriately evaluate disordered metabolism in earlier stages of kidney disease. As a consequence, early and preventive treatment approaches may have to be developed for patients in CKD stages 3-5 to halt progression of CKD-MBD. |
| format | Article |
| id | doaj-art-0604e4d945b74ee4b57dceb014da787b |
| institution | Kabale University |
| issn | 2090-214X 2090-2158 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Nephrology |
| spelling | doaj-art-0604e4d945b74ee4b57dceb014da787b2025-02-03T05:45:03ZengWileyInternational Journal of Nephrology2090-214X2090-21582011-01-01201110.4061/2011/970245970245Phosphate Metabolism in CKD Stages 3–5: Dietary and Pharmacological ControlMarkus Ketteler0Division of Nephrology, Klinikum Coburg, 96450 Coburg, GermanyWhen compared to the available information for patients on dialysis (CKD stage 5D), data on the epidemiology and appropriate treatment of calcium and phosphate metabolism in the predialysis stages of chronic kidney disease (CKD) are quite limited. Perceptible derangements of calcium and phosphate levels start to become apparent when GFR falls below 30 mL/min in some, but not all, patients. However, hyperphosphatemia may be a significant morbidity and mortality risk predictor in predialysis CKD stages. The RIND study, evaluating progression of coronary artery calcification in incident hemodialysis patients, indirectly demonstrated that vascular calcification processes start to manifest in CKD patients prior to the dialysis stage, which may be closely linked to early and invisible derangements in calcium and phosphate homeostasis. Novel insights into the pathophysiology of calcium and phosphate handling such as the discovery of FGF23 and other phosphatonins suggest that a more complex assessment of phosphate balance is warranted, possibly including measurements of fractional phosphate excretion and phosphatonin levels in order to appropriately evaluate disordered metabolism in earlier stages of kidney disease. As a consequence, early and preventive treatment approaches may have to be developed for patients in CKD stages 3-5 to halt progression of CKD-MBD.http://dx.doi.org/10.4061/2011/970245 |
| spellingShingle | Markus Ketteler Phosphate Metabolism in CKD Stages 3–5: Dietary and Pharmacological Control International Journal of Nephrology |
| title | Phosphate Metabolism in CKD Stages 3–5: Dietary and Pharmacological Control |
| title_full | Phosphate Metabolism in CKD Stages 3–5: Dietary and Pharmacological Control |
| title_fullStr | Phosphate Metabolism in CKD Stages 3–5: Dietary and Pharmacological Control |
| title_full_unstemmed | Phosphate Metabolism in CKD Stages 3–5: Dietary and Pharmacological Control |
| title_short | Phosphate Metabolism in CKD Stages 3–5: Dietary and Pharmacological Control |
| title_sort | phosphate metabolism in ckd stages 3 5 dietary and pharmacological control |
| url | http://dx.doi.org/10.4061/2011/970245 |
| work_keys_str_mv | AT markusketteler phosphatemetabolisminckdstages35dietaryandpharmacologicalcontrol |