title: Phosphate handling in CKD-MBD from stage 3 to dialysis and the three strengths of lanthanum carbonate.
abstract: BACKGROUND
  High phosphate levels are associated with unfavorable outcomes in ESRD. Recent data suggested that phosphate levels within the normal range are equally associated with poor outcomes in the community and CKD stage 3 - 4. Several concept papers support the potential role of phosphate load as a first-line toxin in the beginning of CKD-MBD processes via the activation of FGF23 cascade. Phosphate load is thereafter involved in the progression of vascular calcification (VC) and bone disorder typical of CKD-MBD.
  
  
  METHODS
  Herein the authors cover the recent evidence on the pathophysiology of phosphate handling through the natural history of CKD, with particular emphasis on FGF23 cascade, its potential surrogate markers, VC and bone disorder. The major characteristics of lanthanum carbonate are therefore discussed, focusing on its potential advantages for the treatment of difficult cases in CKD-MBD.
  
  
  CONCLUSIONS
  Lanthanum carbonate, being the most potent calcium-free phosphate binder available in clinical practice, could be decisive for those cases where controlling phosphate load is complicated by poor compliance to medications, stubborn high phosphorus intake, extended VC and bone disorders.
authors.affiliation: Renal Division and Laboratory of Experimental Nephrology, Dipartimento di Scienze della Salute, Università di Milano,S. Paolo Hospita, Via A. di Rudinì 8, Milan, Italy. mario.cozzolino@unimi.it
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.forename: Elena
authors.initials: E
authors.lastname: Bruschetta
authors.forename: Daniele
authors.initials: D
authors.lastname: Cusi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Montanari
authors.forename: Maria Enrica
authors.initials: ME
authors.lastname: Giovenzana
authors.forename: Andrea
authors.initials: A
authors.lastname: Galassi
mesh_terms: D000818:Animals; D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000378:metabolism; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000378:metabolism; D006801:Humans; D007811:Lanthanum / Q000008:administration & dosage*; D010710:Phosphates / Q000378:metabolism*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000378:metabolism
chemical_list: C000717427:FGF23 protein, human; D010710:Phosphates; C119467:lanthanum carbonate; D005346:Fibroblast Growth Factors; D007811:Lanthanum; D000089703:Fibroblast Growth Factor-23