Numerous mechanisms are involved in maintaining serum phosphate concentration in the normal range, mainly by regulating phosphate absorption in the gut and tubular phosphate reabsorption in the kidney. In the gut, phosphate is absorbed by passive paracellular diffusion and active transcellular transport, mainly via NPT2b, the major sodium phosphate cotransporter in the small intestine.1 Active phosphate absorption is enhanced by 1,25(OH)2 vitamin D. Intestinal phosphate absorption can be reduced by several approaches,1 including reduction of dietary phosphate intake, chelation of phosphate in the gut lumen,2 specific inhibition of NPT2b activity by small-molecule inhibitors,3 nonspecific inhibition of NPT2b by niacin or its derivative nicotinamide,2 and reduction of passive paracellular phosphate flux via inhibition of the sodium/hydrogen exchanger 3.