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Phosphate Control in Peritoneal Dialysis Patients: Issues, Solutions, and Open Questions

NUTRIENTS (2023)

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Summary: This study found that a baseline dietary protein intake (DPI) less than 0.60g/kg/day was associated with worse outcomes in peritoneal dialysis (PD) patients. PD patients with a DPI of 0.61-0.79g/kg/day had significantly negative nitrogen balance. There was a longitudinal association between time-dependent DPI and survival in PD patients, with consistently low DPI being correlated with increased death risk.

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Summary: Lanthanum carbonate therapy in hemodialysis patients may help slow the progression of coronary artery calcification and left ventricular mass index, reduce serum phosphate, calcium, and FGF23 levels, and decrease the risk of nonfatal cardiovascular events. Further well-designed RCTs are needed for confirmation.

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Summary: Calcium is essential for bone health and nerve signaling, while phosphorus is a key component of ATP and helps regulate metabolic energy. Vitamins D and K are crucial for the absorption and excretion of calcium and phosphorus, with vitamin D playing a regulatory role in various bodily functions.

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Hyperphosphatemia increases inflammation to exacerbate anemia and skeletal muscle wasting independently of FGF23-FGFR4 signaling

Brian Czaya et al.

Summary: Elevated plasma phosphate concentrations can lead to complications such as inflammation, anemia, and skeletal muscle wasting in chronic kidney disease patients. This study found that these complications can also occur in mice with adenine-induced CKD or mice fed a high phosphate diet. However, a low phosphate diet was able to ameliorate anemia and skeletal muscle wasting in a genetic mouse model of CKD. Mechanistic in vitro studies revealed that phosphate elevations induce inflammatory signaling and increase hepcidin expression in hepatocytes. These findings suggest the harmful effects of high phosphate intake, supporting the need to treat hyperphosphatemia in CKD patients and limit phosphate intake in healthy individuals.

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