Marcuccilli Morgan, Chonchol Michel, Jovanovich Anna
Division of Renal Diseases, Hypertension University of Colorado, Denver, Colorado.
Denver VA Medical Center, Denver, Colorado.
Semin Dial. 2017 Mar;30(2):134-141. doi: 10.1111/sdi.12568. Epub 2017 Jan 8.
In advanced renal disease, the kidney is unable to maintain phosphate balance due to decreased urinary excretion as well as the imbalance of the bone metabolic axis. It is well established that hyperphosphatemia is associated with increased cardiovascular events and mortality in patients with chronic kidney disease (CKD). However, there are no randomized controlled trials that demonstrate a clear benefit on hard outcomes in lowering serum phosphate levels to recommended targets in the CKD or dialysis population. In addition, while calcium-based phosphate binders have traditionally been the standard of care in the treatment of hyperphosphatemia, data regarding the increased risk of vascular mineralization continues to emerge. Clinicians continue to search for new phosphate-lowering therapies as well as investigate novel nutritional perspectives. The Kidney Disease: Improving Global Outcomes is currently revising the guidelines on phosphate goals in CKD. This review will outline the history of phosphate targets and phosphate binders, and explore innovative phosphate-lowering therapies. Based on current data, clinicians moving forward should continue to treat end-stage renal disease patients with hyperphosphatemia based on individual risk factors for vascular mineralization.
在晚期肾病中，由于尿排泄减少以及骨代谢轴失衡，肾脏无法维持磷平衡。众所周知，高磷血症与慢性肾脏病（CKD）患者心血管事件增加和死亡率升高有关。然而，尚无随机对照试验表明将CKD或透析人群的血清磷水平降至推荐目标对硬性结局有明确益处。此外，虽然钙基磷结合剂一直是治疗高磷血症的传统标准治疗方法，但有关血管钙化风险增加的数据仍不断出现。临床医生继续寻找新的降磷疗法，并研究新的营养观点。改善全球肾脏病预后组织目前正在修订CKD中磷目标的指南。本综述将概述磷目标和磷结合剂的历史，并探索创新的降磷疗法。根据目前的数据，未来临床医生应继续根据血管钙化的个体风险因素治疗晚期肾病高磷血症患者。
