title: Phosphate balance in ESRD: diet, dialysis and binders against the low evident masked pool.
abstract: Phosphate metabolism is crucial in the pathophysiology of secondary hyperparathyroidism and vascular calcification. High phosphate levels have been consistently associated with unfavorable outcomes in dialysis patients, but several limitations are still hampering a resolutive definition of the optimal targets of phosphate serum levels to be achieved in this cohort. Nonetheless, hyperphosphatemia is a late marker of phosphate overload in humans. Clinical nephrologists routinely counteract the positive phosphate balance in dialysis patients through nutritional counseling, stronger phosphate removal by dialysis and prescription of phosphate binders. However, the superiority against placebo of phosphate control by diet, dialysis or binders in terms of survival has never been tested in dedicated randomized controlled trials. The present review discusses this conundrum with particular emphasis on the rationale supporting the value of a simultaneous intervention against phosphate overload in dialysis patients via the improvement of dietary intakes, dialysis efficiency and an individualized choice of phosphate binders.
authors.affiliation: Department of Medicine, Renal and Dialysis Unit, Desio Hospital, Desio, Italy, andrea.galassi@aovimercate.org.
authors.forename: A
authors.initials: A
authors.lastname: Galassi
authors.forename: A
authors.initials: A
authors.lastname: Cupisti
authors.forename: A
authors.initials: A
authors.lastname: Santoro
authors.forename: M
authors.initials: M
authors.lastname: Cozzolino
mesh_terms: D002614:Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D009752:Nutritional Status; D010710:Phosphates / Q000009:adverse effects / Q000097:blood*; D016226:Phosphorus, Dietary / Q000009:adverse effects / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002614:Chelating Agents; D010710:Phosphates; D016226:Phosphorus, Dietary