Phosphate and bone fracture risk in chronic kidney disease patients.

Maria Fusaro, Rachel Holden, Charmaine Lok, Giorgio Iervasi, Mario Plebani, Andrea Aghi, Maurizio Gallieni, Mario Cozzolino

Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2021;36(3):405-412

PMID: 31620773

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Abstract

In chronic kidney disease (CKD), phosphate homoeostasis plays a central role in the development of mineral and bone disorder (MBD) together with decreased serum calcium and elevated serum parathyroid hormone, fibroblast growth factor 23 and sclerostin levels. Today there are only a few data exploring the direct role of abnormal phosphate homoeostasis and hyperphosphataemia in the development of CKD-MBD. On the other hand, several studies have looked at the link between hyperphosphataemia and cardiovascular morbidity and mortality in CKD, but there is a lack of evidence to indicate that lowering phosphate levels improves cardiovascular outcomes in this population. Furthermore, the impact of liberalizing phosphate targets on CKD-MBD progression and bone fracture is currently not known. In this review we discuss the central role of phosphate in the pathogenesis of CKD-MBD and how it may be associated with fracture risk, both in hyper- and hypophosphataemia.

Address: National Research Council, Institute of Clinical Physiology, Pisa, Italy.; Department of Medicine, University of Padova, Padova, Italy.; Department of Medicine, Division of Nephrology, Queen's University, Kingston, Ontario, Canada.; Department of Medicine, Division of Nephrology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Department of Medicine, Laboratory Medicine Unit, University of Padova, Padova, Italy.; Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy.; Department of Biomedical and Clinical Sciences 'L. Sacco', Nephrology and Dialysis Unit, ASST Fatebenefratelli-Sacco, Università di Milano, Milan, Italy.; Department of Health Sciences, ASST Santi Paolo and Carlo, University of Milan and Renal Division, Milan, Italy.

DOI: 10.1093/ndt/gfz196

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MeSH Terms: Chronic Kidney Disease-Mineral and Bone Disorder, Fractures, Bone, Humans, Phosphates, Prognosis