Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan; Interactive Translational Research Center for Kidney Diseases, Tokai University School of Medicine, Isehara, Japan; The Institute of Medical Sciences, Tokai University, Isehara, Japan.
Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.
Kidney Int. 2016 Oct;90(4):753-63. doi: 10.1016/j.kint.2016.03.039. Epub 2016 Jun 7.
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.
维持磷酸盐平衡对于生命至关重要，哺乳动物在进化过程中已经发展出了一套复杂的系统来调节磷酸盐的体内平衡。然而，由于磷酸盐的排泄依赖于肾脏，肾功能下降的人类很可能处于正磷酸盐平衡状态。磷酸盐过多已被充分认识到是慢性肾脏病相关矿物质和骨代谢紊乱发病机制中的一个关键因素，但最近的研究也揭示了磷酸盐对心血管系统和衰老过程的毒性作用。有说服力的证据还表明，对正磷酸盐平衡的反应增加成纤维细胞生长因子 23 和甲状旁腺激素水平，导致不良的临床结局。这些新认识支持目前对晚期慢性肾脏病患者进行血清磷酸盐管理的做法，尽管缺乏这些影响的确凿证据。鉴于过量磷酸盐的潜在毒性，一般人群也可能被视为磷酸盐管理的目标人群。然而，由于增加磷酸盐摄入对矿物质代谢和临床结局的影响有限，在一般人群中广泛实施磷酸盐饮食干预可能没有必要。尽管如此，在我们老龄化的社会中，肾脏疾病或损伤的发病率不断上升，这凸显了这个问题的潜在重要性。需要进一步的研究来更全面地描述磷酸盐的毒性，并为慢性肾脏病患者和一般人群的磷酸盐管理制定最佳治疗策略。
