Skip to main content

Management of phosphorus load in CKD patients

Clinical and Experimental Nephrology volume 21, pages 27–36 (2017)Cite this article

Abstract

Disturbances in mineral and bone metabolism play a critical role in the pathogenesis of cardiovascular complications in patients with chronic kidney disease (CKD). The term “renal osteodystrophy” has recently been replaced with “CKD-mineral and bone disorder (CKD-MBD)”, which includes vascular calcification as well as bone abnormalities. In Japan, proportions of the aged and long-term dialysis patients are increasing which makes management of vascular calcification and parathyroid function increasingly more important. There are three main strategies to manage phosphate load: phosphorus dietary restriction, administration of phosphate binder and to ensure in the CKD 5D setting, an adequate dialysis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Foley RN, Collins AJ, Herzog CA, Ishani A, Kalra PA. Serum phosphorus levels associate with coronary atherosclerosis in young adults. J Am Soc Nephrol. 2009;20:397–404.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. Schwarz S, Trivedi BK, Kalantar-Zadeh K, Kovesdy CP. Association of disorders in mineral metabolism with progression of chronic kidney disease. Clin J Am Soc Nephrol. 2006;1:825–31.

    CAS  Article  PubMed  Google Scholar 

  3. Adeney KL, Siscovick DS, Ix JH, Seliger SL, Shlipak MG, Jenny NS, Kestenbaum BR. Association of serum phosphate with vascular and valvular calcification in moderate CKD. J Am Soc Nephrol. 2009;20:381–7.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. Sigrist M, Bungay P, Taal MW, McIntyre CW. Vascular calcification and cardiovascular function in chronic kidney disease. Nephrol Dial Transplant. 2006;21:707–14.

    Article  PubMed  Google Scholar 

  5. Chue CD, Edwards NC, Moody WE, Steeds RP, Townend JN, Ferro CJ. Serum phosphate is associated with left ventricular mass in patients with chronic kidney disease: a cardiac magnetic resonance study. Heart. 2012;98:219–24.

    CAS  Article  PubMed  Google Scholar 

  6. Ix JH, De Boer IH, Peralta CA, Adeney KL, Duprez DA, Jenny NS, Siscovick DS, Kestenbaum BR. Serum phosphorus concentrations and arterial stiffness among individuals with normal kidney function to moderate kidney disease in MESA. Clin J Am Soc Nephrol. 2009;4:609–15.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Yilmaz MI, Sonmez A, Saglam M, Yaman H, Kilic S, Eyileten T, Caglar K, Oguz Y, Vural A, Yenicesu M, Mallamaci F, Zoccali C. Comparison of calcium acetate and sevelamer on vascular function and fibroblast growth factor 23 in CKD patients: a randomized clinical trial. Am J Kidney Dis. 2012;59:177–85.

    CAS  Article  PubMed  Google Scholar 

  8. Naylor KL, McArthur E, Lesilie WD, Fraser LA, Jamal SA, Cadarette SM, Pouget JG, Lok CE, Hodsman AB, Adachi JD, Garg AX. The three-year incidence of fracture in chronic kidney disease. Kidney Int. 2014;86:810–8.

    Article  PubMed  Google Scholar 

  9. Eddington H, Hoefield R, Sinha S, Yaman H, Kilic S, Eyileten T, Caglar K, Oguz Y, Vural A, Yenicesu M, Mallamaci F, Zoccali C. Serum phosphate and mortality in patients with chronic kidney disease. Clin J Am Soc Nephrol. 2010;5:2251–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sim JJ, Bhandari SK, Smith N, Chung J, Liu IL, Jacobsen SJ, Kalantar-Zadeh K. Phosphorus and risk of renal failure in subjects with normal renal function. Am J Med. 2013;126:311–8.

    CAS  Article  PubMed  Google Scholar 

  11. Isakova T, Wahl P, Vargas GS, Gutiérrez OM, Scialla J, Xie H, Appleby D, Nessel L, Bellovich K, Chen J, Hamm L, Gadegbeku C, Horwitz E, Townsend RR, Anderson CA, Lash JP, Hsu CY, Leonard MB, Wolf M. Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease. Kidney Int. 2011;79:1370–8.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, Andress DL. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007;71:31–8.

    CAS  Article  PubMed  Google Scholar 

  13. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2009;113:S1–130.

    Google Scholar 

  14. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15:2208–18.

    CAS  Article  PubMed  Google Scholar 

  15. Kalantar-Zadeh K, Kuwae N, Regidor DL, Kovesdy CP, Kilpatrick RD, Shinaberger CS, McAllister CJ, Budoff MJ, Salusky IB, Kopple JD. Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int. 2006;70:771–80.

    CAS  Article  PubMed  Google Scholar 

  16. Kestenbaum B, Sampson JN, Rudser KD, Patterson DJ, Seliger SL, Young B, Sherrard DJ, Andress DL. Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol. 2005;16:520–8.

    CAS  Article  PubMed  Google Scholar 

  17. Fernandez-Martin JL, Martinez-Camblor P, Dionisi MP, Floege J, Ketteler M, London G, Locatelli F, Gorriz JL, Rutkowski B, Ferreira A, Bos WJ, Covic A, Rodríguez-García M, Sánchez JE, Rodríguez-Puyol D, Cannata-Andia JB, COSMOS group. Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: the COSMOS study. Nephrol Dial Transplant. 2015;30:1542–51.

    Article  PubMed  Google Scholar 

  18. Kalantar-Zadeh K, Gutekunst L, Mehrotra R, Kovesdy CP, Bross R, Shinaberger CS, Noori N, Hirschberg R, Benner D, Nissenson AR, Kopple JD, Kalantar-Zadeh K. Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. Clin J Am Soc Nephrol. 2010;5:519–30.

    CAS  Article  PubMed  Google Scholar 

  19. Japanese Society of Nephrology. Dietary recommendation for chronic kidney disease 2014. Jpn J Nephrol. 2014;56:553–99.

    Google Scholar 

  20. Di Iorio B, Di Micco L, Torraca S, Sirico ML, Russo L, Pota A, Mirenghi F, Russo D. Acute effects of very-low-protein diet on FGF23 levels: a randomized study. Clin J Am Soc Nephrol. 2012;7:581–7.

    Article  PubMed  Google Scholar 

  21. Obi Y, Qader H, Kovesdy CP, Kalantar-Zadeh K. Latest consensus and update on protein-energy wasting in chronic kidney disease. Curr Opin Clin Nutr Metab Care. 2015;18:254–62.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. Shah AP, Kalantar-Zadeh K, Kopple JD. Is there a role for ketoacid supplements in the management of CKD? Am J Kidney Dis. 2015;65:659–73.

    CAS  Article  PubMed  Google Scholar 

  23. Cheema BS, Chan D, Fahey P, Atlantis E. Effect of progressive resistance training on measures of skeletal muscle hypertrophy, muscular strength and health-related quality of life in patients with chronic kidney disease: a systematic review and meta-analysis. Sports Med. 2014;44:1125–38.

    Article  PubMed  Google Scholar 

  24. Kirkman DL, Mullins P, Junglee NA, Kumwenda M, Jibani MM, Macdonald JH. Anabolic exercise in haemodialysis patients: a randomised controlled pilot study. J Cachexia Sarcopenia Muscle. 2014;5:199–207.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Noori N, Kalantar-Zadeh K, Kovesdy CP, Bross R, Benner D, Kopple JD. Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clin J Am Soc Nephrol. 2010;5:683–92.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. Taylor LM, Kalantar-Zadeh K, Markewich T, Colman S, Benner D, Sim JJ, Kovesdy CP. Dietary egg whites for phosphorus control in maintenance haemodialysis patients: a pilot study. J Ren Care. 2011;37:16–24.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kalantar-Zadeh K. Patient education for phosphorus management in chronic kidney disease. Patient Prefer Adher. 2013;7:379–90.

    Article  Google Scholar 

  28. Lei XG, Porres JM. Phytase enzymology, applications, and biotechnology. Biotechnol Lett. 2003;25:1787–94.

    CAS  Article  PubMed  Google Scholar 

  29. Moe SM, Zidehsarai MP, Chambers MA, Jackman LA, Radcliffe JS, Trevino LL, Donahue SE, Asplin JR. Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease. Clin J Am Soc Nephrol. 2011;6:257–64.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. Markiewicz LH, Honke J, Haros M, Świątecka D, Wróblewska B. Diet shapes the ability of human intestinal microbiota to degrade phytate—in vitro studies. J Appl Microbiol. 2013;115:247–59.

    CAS  Article  PubMed  Google Scholar 

  31. Sullivan C, Sayre SS, Leon JB, Machekano R, Love TE, Porter D, Marbury M, Sehgal AR. Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. JAMA. 2009;301:629–35.

    CAS  Article  PubMed  Google Scholar 

  32. The Ministry of Health, Labor, and Welfare. The National Health and Nutrition Survey 2014. http://www.mhlw.go.jp/stf/houdou/0000067890.html. Accessed 20 Sep 2016.

  33. The Ministry of Health, Labor and Welfare. Surveys on daily intake levels of food additives by market basket method 2013. http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/shokuhin/syokuten/sesshu/index.html. Accessed 20 Sep 2016

  34. Shutto Y, Yamabe H, Shimada M, Murakami R, Fujita T, Nakamura N. Lack of awareness of phosphate in processed food and drinks among patients with chronic kidney disease. Prog Med. 2013;33:2255–9.

    Google Scholar 

  35. Hager MH, Geiger C, Hill LJ, Martin C, Weiner S, Chianchiano D. Usefulness of nutrition facts label for person with chronic kidney disease. J Ren Nutr. 2009;19:204–10.

    Article  PubMed  Google Scholar 

  36. Karp H, Ekholm P, Kemi V, Itkonen S, Hirvoen T, Närkko S, Lamberg-Allardt C. Differences among total and in vitro digestive phosphorus content of plant foods and beverages. J Ren Nutr. 2012;22:416–22.

    CAS  Article  PubMed  Google Scholar 

  37. Benini O, Saba A, Ferretti V, Gianfaldoni D, Kalantar-Zadeh K, Cupisti A. Development and analytical evaluation of a spectrophotometric procedure for the quantification of different types of phosphorus in meat products. J Agric Food Chem. 2014;12(62):1247–53.

    Article  Google Scholar 

  38. Cupisti A, Comar F, Luoetti S, D’Alessandro C, Barsootti G, Gianfaldoni D. Effect of boiling on dietary phosphate and nitrogen intake. J Ren Nutr. 2006;16:36–40.

    Article  PubMed  Google Scholar 

  39. Ando S, Sakuma M, Morimoto Y, Arai H. The effect of various boiling conditions on reduction of phosphorus and protein in meat. J Ren Nutr. 2015;25:504–9.

    CAS  Article  PubMed  Google Scholar 

  40. Vrdoljak I, Panjkota Krbavčić I, Bituh M, Vrdoljak T, Dujmić Z. Analysis of different thermal processing methods of foodstuffs to optimize protein, calcium, and phosphorus content for dialysis patients. J Ren Nutr. 2015;25:308–15.

    CAS  Article  PubMed  Google Scholar 

  41. Delgado-Andrade C, Seiquer I, Gracia MM, Galdo G, Navarro MP. Increased intake of Maillard reaction products reduces phosphorus digestibility in male adolescents. Nutrition. 2011;27:86–91.

    CAS  Article  PubMed  Google Scholar 

  42. Noori N, Sims JJ, Kopple JD, Shah A, Colman S, Shinaberger CS, Bross R, Mehrotra R, Kovesdy CP, Kalantar-Zadeh K. Organic and inorganic dietary phosphorus and its management in chronic kidney disease. Iran J Kidney Dis. 2010;4:89–100.

    PubMed  Google Scholar 

  43. Taketani Y, Masuda M, Yamanaka-Okumura H, Tatsumi S, Segawa H, Miyamoto K, Takeda E, Yamamoto H. Niacin and chronic kidney disease. J Nutr Sci Vitaminol (Tokyo). 2015;61:S173–5.

    CAS  Article  Google Scholar 

  44. Nishida Y, Taketani Y, Yamanaka-Okumura H, Imamura F, Taniguchi A, Sato T, Shuto E, Nashiki K, Arai H, Yamamoto H, Takeda E. Acute effect of oral phosphate loading on serum fibroblast growth factor 23 levels in healthy men. Kidney Int. 2006;70:2141–7.

    CAS  Article  PubMed  Google Scholar 

  45. van Duynhoven JPM, van Velzen EJJ, Westerhuis JA, Foltz M, Jacobs DM, Smilde AK. Nutrikinetics: concept, technologies, applications, perspectives. Trends Food Sci Technol. 2012;26:4–13.

    Article  Google Scholar 

  46. Shigematsu T, Tokumoto A, Nakaoka A, Arisaka H. Effect of lanthanum carbonate treatment on bone in Japanese dialysis patients with hyperphosphatemia. Ther Apher Dial. 2011;15(2):176–84.

    CAS  Article  PubMed  Google Scholar 

  47. Jamal SA, Vandermeer B, Raggi P, Mendelssohn DC, Chatterley T, Dorgan M, Lok CE, Fitchett D, Tsuyuki RT. Effect of calcium-based versus noncalcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Lancet. 2013;382:1268–77.

    CAS  Article  PubMed  Google Scholar 

  48. Block GA, Wheeler DC, Persky MS, Kestenbaum B, Ketteler M, Spiegel DM, Allison MA, Asplin J, Smits G, Hoofnagle AN, Kooienga L, Thadhani R, Mannstadt M, Wolf M, Chertow GM. Effects of phosphate binders in moderate CKD. J Am Soc Nephrol. 2012;23:1407–15.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  49. Di Iorio B, Bellasi A, Russo D, INDEPENDENT Study Investigators. Mortality in kidney disease patients treated with phosphate binders: a randomized study. Clin J Am Soc Nephrol. 2012;7:487–93.

    Article  PubMed  Google Scholar 

  50. Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010;341:c3691.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Hill KM, Martin BR, Wastney ME, McCabe GP, Moe SM, Weaver CM, Peacock M. Oral calcium carbonate affects calcium but not phosphorus balance in stage 3–4 chronic kidney disease. Kidney Int. 2013;83:959–66.

    CAS  Article  PubMed  Google Scholar 

  52. Block GA, Fishbane S, Rodriguez M, Smits G, Shemesh S, Pergola PE, Wolf M, Chertow GM. A 12-week, doubleblind, placebo-controlled trial of ferric citrate for the treatment of iron deficiency anemia and reduction of serum phosphate in patients with CKD stages 3–5. Am J Kidney Dis. 2015;65:728–36.

    CAS  Article  PubMed  Google Scholar 

  53. Wolf M, White KE. Coupling fibroblast growth factor 23 production and cleavage: iron deficiency, rickets, and kidney disease. Curr Opin Nephrol Hypertens. 2014;23:411–9.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  54. National Kidney F. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(4 Suppl 3):S1–201.

    Google Scholar 

  55. Fukagawa M, Yokoyama K, Koiwa F, Taniguchi M, Shoji T, Kazama JJ, Komaba H, Ando R, Kakuta T, Fujii H, Nakayama M, Shibagaki Y, Fukumoto S, Fujii N, Hattori M, Ashida A, Iseki K, Shigematsu T, Tsukamoto Y, Tsubakihara Y, Tomo T, Hirakata H, Akizawa T, CKD-MBD Guideline Working Group, Japanese Society for Dialysis Therapy. Clinical practice guideline for the management of chronic kidney disease-mineral and bone disorder. Ther Apher Dial. 2013;17(3):247–88.

    Article  PubMed  Google Scholar 

  56. Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis. 1990;15:458–82.

    CAS  Article  PubMed  Google Scholar 

  57. Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998;31:607–17.

    CAS  Article  PubMed  Google Scholar 

  58. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO(4), Ca × PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001;12:2131–8.

    CAS  PubMed  Google Scholar 

  59. Stevens LA, Djurdjev O, Cardew S, Cameron EC, Levin A. Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol. 2004;15:770–9.

    CAS  Article  PubMed  Google Scholar 

  60. Young EW, Albert JM, Satayathum S, Goodkin DA, Pisoni RL, Akiba T, Akizawa T, Kurokawa K, Bommer J, Piera L, Port FK. Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Pattern Study. Kidney Int. 2005;67:1179–87.

    CAS  Article  PubMed  Google Scholar 

  61. Slinin Y, Foley RN, Collins AJ. Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4 study. J Am Soc Nephrol. 2005;16:1788–93.

    CAS  Article  PubMed  Google Scholar 

  62. Rodriguez-Benot A, Martin-Malo A, Alvarez-Lara MA, Rodriguez M, Aljama P. Mild hyperphosphatemia and mortality in hemodialysis patients. Am J Kidney Dis. 2005;46:68–77.

    CAS  Article  PubMed  Google Scholar 

  63. Noordzij M, Korevaar JC, Boeschoten EW, Dekker FW, Bos WJ, Krediet RT. Netherlands Cooperative Study on the Adequacy of Dialysis: the Kidney Disease Outcomes Quality Initiative (K/DOQI) Guideline for Bone Metabolism and Disease in CKD: association with mortality in dialysis patients. Am J Kidney Dis. 2005;46:925–32.

    Article  PubMed  Google Scholar 

  64. Floege J, Kim J, Ireland E, Chazot C, Drueke T, de Francisco A, Kronenberg F, Marcelli D, Passlick-Deetjen J, Schernthaner G, Fouqueray B, Wheeler DC. ARO Investigators: serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant. 2011;26:1948–55.

    CAS  Article  PubMed  Google Scholar 

  65. Taniguchi M, Fukagawa M, Fujii N, Hamano T, Shoji T, Yokoyama K, Nakai S, Shigematsu T, Iseki K, Tsubakihara Y, Committee of Renal Data Registry of the Japanese Society for Dialysis Therapy. Serum phosphate and calcium should be primarily and consistently controlled in prevalent hemodialysis patients. Ther Apher Dial. 2013;17(2):221–8.

    CAS  Article  PubMed  Google Scholar 

  66. Lynch KE, Lynch R, Curhan GC, Brunelli SM. Prescribed dietary phosphate restriction and survival among hemodialysis patients. Clin J Am Soc Nephrol. 2011;6(3):620.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  67. Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T, Wakai K, Wada A, Nitta K. An overview of regular dialysis treatment in Japan (as of 31 December 2013). Ther Apher Dial. 2015;19(6):540–74.

    CAS  Article  PubMed  Google Scholar 

  68. Shinaberger CS, Greenland S, Kopple JD, Van Wyck D, Mehrotra R, Kovesdy CP, Kalantar-Zadeh K. Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease? Am J Clin Nutr. 2008;88:1511–8.

    CAS  Article  PubMed  Google Scholar 

  69. Palmer SC, Gardner S, Tonelli M, Mavridis D, Johnson DW, Craig JC, French R, Ruospo M, Strippoli GF. Association of drug effects on serum parathyroid hormone, phosphorus, and calcium levels with mortality in CKD: a meta-analysis. Am J Kidney Dis. 2015;66(6):962–71.

    CAS  Article  PubMed  Google Scholar 

  70. Isakova T, Gutiérrez OM, Chang Y, Shah A, Tamez H, Smith K, Thadhani R, Wolf M. Phosphorus binders and survival on hemodialysis. J Am Soc Nephrol. 2009;20(2):388.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  71. Yokoyama K, Akiba T, Fukagawa M, Nakayama M, Sawada K, Kumagai Y, Chertow GM, Hirakata H. Long-term safety and efficacy of a novel iron-containing phosphate binder, JTT-751, in patients receiving hemodialysis. J Ren Nutr. 2014;24(4):261–7.

    CAS  Article  PubMed  Google Scholar 

  72. Koiwa F, Yokoyama K, Fukagawa M, Terao A, Akizawa T. Efficacy and safety of sucroferric oxyhydroxide compared with sevelamer hydrochloride in Japanese haemodialysis patients with hyperphosphatemia: a randomised, open-label, multicentre, 12-week phase III study. Nephrology (Carlton). 2016;. doi:10.1111/nep.12891 (Epub ahead of print).

    Google Scholar 

  73. Lenglet A, Liabeuf S, El Esper N, Brisset S, Mansour J, Lemaire-Hurtel AS, Mary A, Brazier M, Kamel S, Mentaverri R, Choukroun G, Fournier A, Massy ZA. Efficacy and safety of nicotinamide in haemodialysis patients: the NICOREN study. Nephrol Dial Transplant. 2016. doi:10.1093/ndt/gfw042.

    PubMed  Google Scholar 

  74. Block GA, Rosenbaum DP, Leonsson-Zachrisson M, Stefansson BV, Rydén-Bergsten T, Greasley PJ, Johansson SA, Knutsson M, Carlsson BC. Effect of tenapanor on interdialytic weight gain in patients on hemodialysis. Clin J Am Soc Nephrol. 2016;11:1597–605.

    Article  PubMed  Google Scholar 

  75. Chang AR, Grams ME. Serum phosphorus and mortality in the Third National Health and Nutrition Examination Survey (NHANES III): effect modification by fasting. Am J Kidney Dis. 2014;64(4):567–73.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  76. Yoda K, Imanishi Y, Yoda M, Mishima T, Ichii M, Yamada S, Mori K, Emoto M, Inaba M. Impaired response of FGF-23 to oral phosphate in patients with type 2 diabetes: a possible mechanism of atherosclerosis. J Clin Endocrinol Metab. 2012;97(11):E2036–43.

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

This supplement is supported by grants from The Japanese Society for Kidney Bone Disease (JSKBD) and from the Research Meeting on Kidney and Metabolic Bone Disease.

Author information

Affiliations

  1. Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan

    Yutaka Taketani

  2. Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan

    Fumihiko Koiwa

  3. Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Keitaro Yokoyama

Authors
  1. Yutaka Taketani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fumihiko Koiwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keitaro Yokoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keitaro Yokoyama.

Ethics declarations

Conflict of interest

K. Y. had received consultant fees from Torii pharmaceutical Co. and received honoraria fees form Torii pharmaceutical Co. and Kyowa Hakko Kirin pharmaceutical Co. F. K. had received consultant fees from Kissei pharmaceutical Co. and received honoraria fees form Kissei pharmaceutical Co. and Kyowa Hakko Kirin pharmaceutical Co.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Taketani, Y., Koiwa, F. & Yokoyama, K. Management of phosphorus load in CKD patients. Clin Exp Nephrol 21, 27–36 (2017). https://doi.org/10.1007/s10157-016-1360-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-016-1360-y

Keywords

  • CKD-MBD
  • Phosphorus
  • Dietary management
  • Phosphate binder