Phosphate in chronic kidney disease progression

A direct and independent association between serum phosphate (P) levels and mortality has been reported. High circulating P concentrations, still within the normal range, was associated with unfavourable outcomes in normal subjects as well as in chronic kidney disease (CKD) patients. Experimental data support the notion that P overload may hamper survival expectancy, directly inducing vascular, skeletal, and renal ageing. The balance of P results from dietary intake, intestinal absorption, glomerular filtration, tubular resorption, and hormonal asset. However, the accurate estimation of P balance is hampered by several methodological weaknesses, becoming even critical when renal function declines. Increasing evidence in the physiology of P metabolism in humans counteracts with uncertainties on dietary P intake and P balance assessment from general population and CKD subjects.