Department of Nephrology, Hypertension and Internal Medicine, University of Warmia and Mazury in Olsztyn,10561 Olsztyn, Poland.
Nutrients. 2021 Feb 27;13(3):789. doi: 10.3390/nu13030789.
Phosphorus is an essential nutrient that is critically important in the control of cell and tissue function and body homeostasis. Phosphorus excess may result in severe adverse medical consequences. The most apparent is an impact on cardiovascular (CV) disease, mainly through the ability of phosphate to change the phenotype of vascular smooth muscle cells and its contribution to pathologic vascular, valvular and other soft tissue calcification. Chronic kidney disease (CKD) is the most prevalent chronic disease manifesting with the persistent derangement of phosphate homeostasis. Diabetes and resulting diabetic kidney disease (DKD) remain the leading causes of CKD and end-stage kidney disease (ESRD) worldwide. Mineral and bone disorders of CKD (CKD-MBD), profound derangement of mineral metabolism, develop in the course of the disease and adversely impact on bone health and the CV system. In this review we aimed to discuss the data concerning CKD-MBD in patients with diabetes and to analyze the possible link between hyperphosphatemia, certain biomarkers of CKD-MBD and high dietary phosphate intake on prognosis in patients with diabetes and DKD. We also attempted to clarify if hyperphosphatemia and high phosphorus intake may impact the onset and progression of DKD. Careful analysis of the available literature brings us to the conclusion that, as for today, no clear recommendations based on the firm clinical data can be provided in terms of phosphorus intake aiming to prevent the incidence or progression of diabetic kidney disease.
磷是一种必需的营养物质，对于控制细胞和组织功能以及体内平衡至关重要。磷过量可能导致严重的不良医学后果。最明显的是对心血管（CV）疾病的影响，主要是通过磷酸盐改变血管平滑肌细胞表型及其对病理性血管、瓣膜和其他软组织钙化的贡献。慢性肾脏病（CKD）是最常见的慢性疾病，表现为磷稳态持续失调。糖尿病和由此导致的糖尿病肾病（DKD）仍然是全球 CKD 和终末期肾病（ESRD）的主要原因。矿物质和骨代谢紊乱的 CKD（CKD-MBD），即矿物质代谢的严重失调，在疾病过程中发展，并对骨骼健康和心血管系统产生不利影响。在这篇综述中，我们旨在讨论糖尿病患者 CKD-MBD 的相关数据，并分析高磷血症、某些 CKD-MBD 生物标志物与高膳食磷摄入与糖尿病和 DKD 患者预后之间的可能联系。我们还试图阐明高磷血症和高磷摄入是否会影响 DKD 的发生和进展。对现有文献的仔细分析使我们得出结论，就目前而言，基于确凿的临床数据，无法提供针对磷摄入的明确建议，以预防糖尿病肾病的发生或进展。
