Abstract:

Normal phosphorus balance mainly depends on the diet intake,body utilzation,and renal excretion. Serum phosphorus is maintained within a physiologic range between 2.5 and 4.5 mg/dl by a series of factors including dietary phosphorus content, parathyroid hormone, and active vitamin D, which can regulate the expression of sodium-phosphate co-transporters that determine phosphate transport in the epithelial cells of both small intestine and renal proximal tubules. At the early stage of renal insufficiency,phosphorus balance is maintained by a compensatory decrease of renal tubular reabsorption of phosphorus which is mediated by elevated parathyroid hormone and fibroblast growth factor-23. As the late stage of renal insufficiency when nephrons are further reduced, total phosphorus excretion cannot keep pace with phosphorus increasing and hyperphosphatemia occurs. Hyperphosphatemia has proved to be closely related to cardiovascular events incidence and mortality. Currently, the incidence of hyperphosphatemia remains high among hemodialysis patients in China, even though the recommended treatments such as phosphorus restricted diet, phosphate binders, and dialysis have been used widely. No guidance from the dietitian,relatively low dose of dialysis, and lack of new type phosphate-binders might be the main reasons.Personalized treatment based on assessment of phosphorus balance by quantification of dietary intake, urinary excretion, dialysis removal, and absorption by phosphorus binders, etc, might be the key to achieve adequate control of hyperphosphatemia. This review is focussed on phosphorus metabolism in both healthy persons and CKD patients, and on progress in the treatment strategy of hyperphosphatemia.

Key words: Chronic kidney disease, Hyperphosphatemia, Personalized treatment