Chapter 17 - Disorders of phosphorus homeostasis: emerging targets for slowing progression of chronic kidney disease

Abstract

Disorders of phosphorus metabolism are independent risk factors for the progression of chronic kidney disease (CKD). Since excess dietary phosphorus intake plays a central role in the pathogenesis of disordered phosphorus homeostasis in CKD, these findings support restricting phosphorus intake as a potential therapy for slowing kidney function decline. While the balance of experimental and human data supports this possibility, the lack of randomized, controlled trials examining the efficacy of dietary phosphorus restriction in CKD patients precludes the ability to advocate phosphorus restriction for preserving kidney function at this time. Future studies will need to determine whether limiting phosphorus intake is effective for slowing CKD progression and if so, studies will need to determine the optimal timing of phosphorus restriction, appropriate targets of therapy, and strategies for safely prescribing phosphorus restriction in clinical practice. Given the markedly high-phosphorus content of westernized diets, these studies should be a high priority in future research.