Ketteler Markus, Wüthrich Rudolf P, Floege Jürgen
Division of Nephrology , Coburg Clinic and KfH-Dialysis Center , Coburg , Germany.
Division of Nephrology , University Hospital , Zürich , Switzerland.
Clin Kidney J. 2013 Apr;6(2):128-36. doi: 10.1093/ckj/sfs173. Epub 2013 Jan 16.
Hyperphosphataemia is a clinical consequence of the advanced stages of chronic kidney disease (CKD). Considerable evidence points to a role of hyperphosphataemia in the pathogenesis of CKD-associated cardiovascular (CV) complications, including vascular calcification, and with increased all-cause and CV mortality. These observations place management of hyperphosphataemia at the centre of CKD treatment. Although our increased understanding of the physiological role of FGF-23 may provide a long-term alternative biomarker of phosphate load and underlying disease progression, regular determination of serum phosphate is currently the most frequently used parameter to evaluate phosphate load in clinical practice. This review considers the challenges physicians and patients face in trying to control hyperphosphataemia. Amongst these are the limitations of dietary phosphate restriction, giving rise to the need for phosphate binder therapy to maintain serum phosphate control. Once the decision to use phosphate binders has been made, considerations include the relative efficacy, different potential side effects and pill burden associated with various phosphate binders. Although a number of phosphate binders are available, adherence poses a major obstacle to effective treatment. This emphasizes that further improvements to phosphate binder therapy can be made. Evaluation of novel agents and their potential role in the clinic should continue.
高磷血症是慢性肾脏病（CKD）晚期的临床后果。大量证据表明，高磷血症在CKD相关心血管（CV）并发症的发病机制中起作用，包括血管钙化，并导致全因死亡率和CV死亡率增加。这些观察结果使高磷血症的管理成为CKD治疗的核心。尽管我们对成纤维细胞生长因子-23（FGF-23）生理作用的进一步了解可能会提供一个长期的替代生物标志物，用于评估磷负荷和潜在疾病进展，但目前在临床实践中，定期测定血清磷是评估磷负荷最常用的参数。本综述探讨了医生和患者在控制高磷血症方面面临的挑战。其中包括饮食磷限制的局限性，这就需要使用磷结合剂治疗来维持血清磷的控制。一旦决定使用磷结合剂，需要考虑的因素包括各种磷结合剂的相对疗效、不同的潜在副作用和药丸负担。尽管有多种磷结合剂可供选择，但依从性是有效治疗的主要障碍。这强调了磷结合剂治疗仍有进一步改进的空间。对新型药物及其在临床中的潜在作用的评估应继续进行。
