Abstract
The increase of urinary fractional excretion of phosphorus (uFEP) may indicate phosphorus retention before the onset of hyperphosphatemia in the early stages of chronic kidney disease (CKD). The hypothesis of this study is whether uFEP may increase during the early stage of CKD as a compensatory mechanism to prevent hyperphosphatemia as well as whether hyperphosphatemia in the late stages is associated with increase or decrease in uFEP in dogs with naturally occurring CKD; therefore, the aim of this study was to determine the uFEP in CKD dogs with different stages. Forty-nine CKD dogs were included, and they were divided into stage 1 (serum creatinine < 1.4 mg/dL), stage 2 (serum creatinine 1.5 to 2.0 mg/dL), stage 3 (serum creatinine 2.1 to 5.0 mg/dL) and stage 4 (serum creatinine > 5.0 mg/dL), according to the IRIS staging criteria. The stage 3 was subdivided into stage 3-A (serum creatinine 2.1 to 3.5 mg/dL) and stage 3-B (serum creatinine 3.6 to 5.0 mg/dL). The control group comprised 10 dogs, and uFEP ≤ 40% was considered as normal. A progressive increase in uFEP along the progression of CKD was found. However, similar results of uFEP levels were observed in late CKD, since there were no differences between stages 3 (A, B) and 4. Interestingly, some CKD dogs with stage 4 showed normal or reduced uFEP, besides hyperphosphatemia; conversely, some dogs in early CKD had increased uFEP values and normophosphatemia. Our findings suggest that uFEP may act as a compensatory mechanism to avoid the onset of hyperphosphatemia in early CKD, but not in later stages. uFEP assessment may be considered as an additional tool for the diagnostic and monitoring of phosphate disorders in dogs with CKD, since it may help to identify disturbances of phosphorus balance. More studies are needed to elucidate the role of uFEP in phosphorus homeostasis in dogs with CKD.
Highlights
The kidney plays an essential role in phosphorus homeostasis, since phosphate is primarily excreted in urine
The aim of this study was to determine the urinary fractional excretion of phosphorus (uFEP) values in chronic kidney disease (CKD) dogs with different stages, and the hypothesis is whether uFEP may increase during the early stage of CKD as a compensatory mechanism to prevent hyperphosphatemia as well as whether in the late stages hyperphosphatemia is associated with decrease in uFEP, just as it occurs in humans with CKD
The mean of serum phosphorus concentrations was markedly increased in CKD dogs with stage 3-B and stage 4, and the mean of uFEP was increased in CKD dogs from stages 3-A to 4 (Table 2)
Summary
The kidney plays an essential role in phosphorus homeostasis, since phosphate is primarily excreted in urine. In chronic kidney disease (CKD), the loss of renal mass leads to a decrease in the glomerular filtration rate (GFR), reducing the urinary excretion of phosphorus. Further hyperphosphatemia, is associated with the development of renal hyperparathyroidism and disease progression. The phosphorus control in CKD is a very important therapeutic strategy in order to avoid CKD progression [1,2].
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