Derangements in Phosphate Metabolism in Chronic Kidney Diseases/Endstage Renal Disease: Therapeutic Considerations

Judicious control of PO4 early in CKD, possibly monitored by measures of FGF-23, could potentially reduce the risk of development of renal secondary hyperparathyroidism and all of the adverse clinical consequences of poorly controlled CKD-mineral and bone disorder. The mainstays of therapy are likely to include a balance of dietary restriction and PO4 binders to reduce PO4 input, and in ESRD patients, dialysis modalities to augment PO4 output.