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Phosphate is a vascular toxin
- Source :
- Pediatric Nephrology. April 1, 2013, Vol. 28 Issue 4, p583, 11 p.
- Publication Year :
- 2013
-
Abstract
- Elevated phosphate (P) levels are seen in advanced renal failure and, together with dysregulated calcium, parathyroid hormone and vitamin D levels, contribute to the complex of chronic kidney disease-mineral and bone disease (CKD-MBD). Converging evidence from in vitro, clinical and epidemiological studies suggest that increased P is associated with vascular calcification and mortality. When vessels are exposed to high P conditions in vitro, they develop apoptosis, convert to bone-like cells and develop extensive calcification. Clinical studies in children on dialysis show that high P is associated with increased vessel wall thickness, arterial stiffness and coronary calcification. Epidemiological studies in adult dialysis patients demonstrate a significant and independent association between raised P and mortality. Importantly, raised P is associated with cardiovascular changes even in pre-dialysis CKD, and also in subjects with normal renal function but high P. All P binders can effectively reduce serum P, and this decrease is linked to improved survival. Raised serum P triggers the release of fibroblast growth factor 23 (FGF-23), which has the beneficial effect of increasing P excretion in early CKD, but is increased several 1,000-fold in dialysis, and may be an independent cardiovascular risk factor. Both FGF-23 and its co-receptor Klotho may have direct effects on the vasculature leading to calcification. Fascinatingly, disturbances in FGF-23-Klotho and raised P have also been associated with premature aging. These data suggest that high P levels have adverse vascular effects and that maintaining the serum P levels in the normal range reduces cardiovascular risk and mortality. Keywords Phosphate * Chronic kidney disease * Cardiovascular disease * Vascular calcification * Dialysis<br />Introduction Phosphorus is an essential element that forms a key component of nucleic acids and cell membranes and is required for maintaining the normal homeostatic control of the cell, including [...]
Details
- Language :
- English
- ISSN :
- 0931041X
- Volume :
- 28
- Issue :
- 4
- Database :
- Gale General OneFile
- Journal :
- Pediatric Nephrology
- Publication Type :
- Academic Journal
- Accession number :
- edsgcl.334845082
- Full Text :
- https://doi.org/10.1007/s00467-012-2347-x