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Hyperphosphatemia and Chronic Kidney Disease: A Major Daily Concern Both in Adults and in Children

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Abstract

Hyperphosphatemia is common in chronic kidney disease (CKD). Often seen as the “silent killer” because of its dramatic effect on vascular calcifications, hyperphosphatemia explains, at least partly, the onset of the complex mineral and bone disorders associated with CKD (CKD–MBD), together with hypocalcemia and decreased 1-25(OH)2 vitamin D levels. The impact of CKD–MBD may be immediate with abnormalities of bone and mineral metabolism with secondary hyperparathyroidism and increased FGF23 levels, or delayed with poor growth, bone deformities, fractures, and vascular calcifications, leading to increased morbidity and mortality. The global management of CKD–MBD has been detailed in international guidelines for adults and children, however, with difficulties to obtain an agreement on the ideal PTH targets. The clinical management of hyperphosphatemia is a daily challenge for nephrologists and pediatric nephrologists, notably because of the phosphate overload in occidental diets that is mainly due to the phosphate “hidden” in food additives. The management begins with a dietary restriction of phosphate intake, and is followed by the use of calcium-based and non-calcium-based phosphate binders, and/or the intensification of dialysis. The objective of this review is to provide an overview of the pathophysiology of hyperphosphatemia in CKD, with a focus on its deleterious effects and a description of the clinical management of hyperphosphatemia in a more global setting of CKD–MBD.

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Authors and Affiliations

  1. Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Centre de Référence Des Maladies Rénales Rares, Centre de Référence Des Maladies Rares du Calcium et du Phosphore, Hôpital Femme Mère Enfant, Boulevard Pinel, 69677, Bron Cedex, France

    Justine Bacchetta, Charlotte Garnier, Corentin Naud & Bruno Ranchin

  2. Université de Lyon, Lyon, France

    Justine Bacchetta

  3. INSERM 1033 Research Unit, Lyon, France

    Justine Bacchetta

  4. Unité de Néphrologie pédiatrique, Hôpital L’Archet, CHU de Nice, Nice, France

    Julie Bernardor

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  3. Charlotte Garnier
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  4. Corentin Naud
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  5. Bruno Ranchin
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Correspondence to Justine Bacchetta.

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Justine Bacchetta, Julie Bernardor, Charlotte Garnier, Corentin Naud, and Bruno Ranchin declare that they have no conflict of interest.

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Bacchetta, J., Bernardor, J., Garnier, C. et al. Hyperphosphatemia and Chronic Kidney Disease: A Major Daily Concern Both in Adults and in Children. Calcif Tissue Int 108, 116–127 (2021). https://doi.org/10.1007/s00223-020-00665-8

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