Advances in Kidney Disease and Health

Intracellular phosphate is critical for cellular processes such as signaling, nucleic acid synthesis, and membrane function. Extracellular phosphate (Pi) is an important component of the skeleton. Normal levels of serum phosphate are maintained by the coordinated actions of 1,25-dihydroxyvitamin D3, parathyroid hormone and fibroblast growth factor-23, which intersect in the proximal tubule to control the reabsorption of phosphate via the sodium-phosphate cotransporters Npt2a and Npt2c. Furthermore, 1,25-dihydroxyvitamin D3 participates in the regulation of dietary phosphate absorption in the small intestine. Clinical manifestations associated with abnormal serum phosphate levels are common and occur as a result of genetic or acquired conditions affecting phosphate homeostasis. For example, chronic hypophosphatemia leads to osteomalacia in adults and rickets in children. Acute severe hypophosphatemia can affect multiple organs leading to rhabdomyolysis, respiratory dysfunction, and hemolysis. Patients with impaired kidney function, such as those with advanced CKD, have high prevalence of hyperphosphatemia, with approximately two-thirds of patients on chronic hemodialysis in the United States having serum phosphate levels above the recommended goal of 5.5 mg/dL, a cutoff associated with excess risk of cardiovascular complications. Furthermore, patients with advanced kidney disease and hyperphosphatemia (>6.5 mg/dL) have almost one-third excess risk of death than those with phosphate levels between 2.4 and 6.5 mg/dL. Given the complex mechanisms that regulate phosphate levels, the interventions to treat the various diseases associated with hypophosphatemia or hyperphosphatemia rely on the understanding of the underlying pathobiological mechanisms governing each patient condition.

Ignacio Portales-Castillo

Timo Rieg

Sheikh B. Khalid

Sagar U. Nigwekar

Javier A. Neyra

Physiopathology of Phosphate Disorders

磷酸盐紊乱的病理生理学

Donal J. Sexton

Serena Bagnasco

Sam Kant

Transplant Nephrology

移植肾病学

Anjay Rastogi

Glenn M. Chertow

Ashté Collins

Ellie Kelepouris

Wayne Kotzker

John P. Middleton

Minesh Rajpal

Prabir Roy-Chaudhury

Utilization of Potassium Binders for the Management of Hyperkalemia in Chronic Kidney Disease: A Position Statement by US Nephrologists

美国肾脏病学家关于慢性肾脏病高钾血症管理中使用钾结合剂的立场声明

出版信息	出版商: W.B. Saunders，出版周期: ，期刊类型: journal，开源期刊: 否
基本数据	创刊年份: 2023，原创研究文献占比: ，自引率:， Gold OA占比:

Advances in Kidney Disease and Health

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Physiopathology of Phosphate Disorders

Transplant Nephrology

Utilization of Potassium Binders for the Management of Hyperkalemia in Chronic Kidney Disease: A Position Statement by US Nephrologists

Autosomal Dominant Polycystic Kidney Disease

Chronic Dialysis Therapies

Transplant Nephrology

Utilization of Potassium Binders for the Management of Hyperkalemia in Chronic Kidney Disease: A Position Statement by US Nephrologists

Autosomal Dominant Polycystic Kidney Disease

Chronic Dialysis Therapies

Metabolic Alkalosis