Phosphate-a poison for humans?
- PMID: 27282935
- DOI: 10.1016/j.kint.2016.03.039
Phosphate-a poison for humans?
Abstract
Maintenance of phosphate balance is essential for life, and mammals have developed a sophisticated system to regulate phosphate homeostasis over the course of evolution. However, due to the dependence of phosphate elimination on the kidney, humans with decreased kidney function are likely to be in a positive phosphate balance. Phosphate excess has been well recognized as a critical factor in the pathogenesis of mineral and bone disorders associated with chronic kidney disease, but recent investigations have also uncovered toxic effects of phosphate on the cardiovascular system and the aging process. Compelling evidence also suggests that increased fibroblastic growth factor 23 and parathyroid hormone levels in response to a positive phosphate balance contribute to adverse clinical outcomes. These insights support the current practice of managing serum phosphate in patients with advanced chronic kidney disease, although definitive evidence of these effects is lacking. Given the potential toxicity of excess phosphate, the general population may also be viewed as a target for phosphate management. However, the widespread implementation of dietary phosphate intervention in the general population may not be warranted due to the limited impact of increased phosphate intake on mineral metabolism and clinical outcomes. Nonetheless, the increasing incidence of kidney disease or injury in our aging society emphasizes the potential importance of this issue. Further work is needed to more completely characterize phosphate toxicity and to establish the optimal therapeutic strategy for managing phosphate in patients with chronic kidney disease and in the general population.
Keywords: chronic kidney disease; fibroblastic growth factor 23; parathyroid hormone; phosphate.
Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
Similar articles
-
Derangements in phosphate metabolism in chronic kidney diseases/endstage renal disease: therapeutic considerations.Adv Chronic Kidney Dis. 2011 Mar;18(2):120-31. doi: 10.1053/j.ackd.2011.02.004. Adv Chronic Kidney Dis. 2011. PMID: 21406297 Review.
-
Regulation of hormone-sensitive renal phosphate transport.Vitam Horm. 2015;98:249-306. doi: 10.1016/bs.vh.2015.01.002. Epub 2015 Mar 6. Vitam Horm. 2015. PMID: 25817872 Review.
-
Phosphate Toxicity in CKD: The Killer among Us.Clin J Am Soc Nephrol. 2016 Jun 6;11(6):1088-1100. doi: 10.2215/CJN.11901115. Epub 2016 Feb 10. Clin J Am Soc Nephrol. 2016. PMID: 26912542 Free PMC article. Review.
-
[Strategies aiming to control hyperphosphatemia in chronic kidney disease].Nephrol Ther. 2017 Apr;13 Suppl 1:S95-S101. doi: 10.1016/j.nephro.2017.01.002. Nephrol Ther. 2017. PMID: 28577750 Review. French.
-
Role of fibroblast growth factor 23 in phosphate homeostasis and pathogenesis of disordered mineral metabolism in chronic kidney disease.Semin Dial. 2007 Jul-Aug;20(4):302-8. doi: 10.1111/j.1525-139X.2007.00308.x. Semin Dial. 2007. PMID: 17635819 Review.
Cited by
-
Inhibition of mitochondrial phosphate carrier prevents high phosphate-induced superoxide generation and vascular calcification.Exp Mol Med. 2023 Mar;55(3):532-540. doi: 10.1038/s12276-023-00950-0. Epub 2023 Mar 1. Exp Mol Med. 2023. PMID: 36854772 Free PMC article.
-
Genetic Evidence for a Causal Role of Serum Phosphate in Coronary Artery Calcification: The Rotterdam Study.J Am Heart Assoc. 2022 Aug 2;11(15):e023024. doi: 10.1161/JAHA.121.023024. Epub 2022 Jul 29. J Am Heart Assoc. 2022. PMID: 35904204 Free PMC article.
-
An introduction to CKD-MBD research: restart for the future.Clin Exp Nephrol. 2017 Mar;21(Suppl 1):1-3. doi: 10.1007/s10157-016-1372-7. Clin Exp Nephrol. 2017. PMID: 28083765 No abstract available.
-
The Significance of the Bifunctional Kinase/Phosphatase Activities of Diphosphoinositol Pentakisphosphate Kinases (PPIP5Ks) for Coupling Inositol Pyrophosphate Cell Signaling to Cellular Phosphate Homeostasis.J Biol Chem. 2017 Mar 17;292(11):4544-4555. doi: 10.1074/jbc.M116.765743. Epub 2017 Jan 26. J Biol Chem. 2017. PMID: 28126903 Free PMC article.
-
Molecular Mechanisms of Vascular Health: Insights From Vascular Aging and Calcification.Arterioscler Thromb Vasc Biol. 2023 Jan;43(1):15-29. doi: 10.1161/ATVBAHA.122.317332. Epub 2022 Nov 22. Arterioscler Thromb Vasc Biol. 2023. PMID: 36412195 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical