Focusing on Phosphorus Loads: From Healthy People to Chronic Kidney Disease

Abstract

Phosphorus is an essential micromineral with a key role in cellular metabolism and tissue structure. Serum phosphorus is maintained in a homeostatic range by the intestines, bones, and kidneys. This process is coordinated by the endocrine system through the highly integrated actions of several hormones, including FGF23, PTH, Klotho, and 1,25D. The excretion kinetics of the kidney after diet phosphorus load or the serum phosphorus kinetics during hemodialysis support that there is a “pool” for temporary phosphorus storage, leading to the maintenance of stable serum phosphorus levels. Phosphorus overload refers to a state where the phosphorus load is higher than is physiologically necessary. It can be caused by a persistently high-phosphorus diet, renal function decline, bone disease, insufficient dialysis, and inappropriate medications, and includes but is not limited to hyperphosphatemia. Serum phosphorus is still the most commonly used indicator of phosphorus overload. Trending phosphorus levels to see if they are chronically elevated is recommended instead of a single test when judging phosphorus overload. Future studies are needed to validate the prognostic role of a new marker or markers of phosphorus overload.

piRNAs and miRNAs Can Bind to mRNA of <i>KLOTHO</i> and <i>FGF23</i> Genes

“…The FGF23 gene is a member of a large family of fibroblast growth factors [94], which is most associated with the KLOTHO gene in anti-aging processes [95]. A number of publications have examined the relationship of FGF23 and KLOTHO genes in physiological processes and in various diseases [96][97][98][99][100][101][102][103][104]. In this regard, we studied the possible effect of piRNA on the expression of the FGF23 gene.…”

“…A decrease in the synthesis of this protein is observed in patients with CKD, which may underlie diabetes [6][7][8][9]. Mutations in KLOTHO protein are associated with aging and loss of bone mass and phosphorus metabolism [10,11]. Several works are devoted to elucidating the role of KLOTHO in oncological diseases [12][13][14][15].…”

Determination of Serum Zinc and Phosphorus Levels in Patients with Hypothyroidism

“…It was suggested that the management of serum P can play a signi cant role in weight loss in individuals and chronic diseases [11,37]. Assessment of serum P levels is essential in patients with hypothyroidism, because elevated serum phosphorus levels may increase the disease complications and be associated with microvascular dysfunction [38], coronary artery calci cation [39], chronic kidney disease [40], and cardiac arrest [41].…”

Myocardial Remodeling in Early Chronic Kidney Disease—Mineral and Bone Disorder Model with Low Bone Turnover

“…One should take into consideration features of lower bone turnover in all of the applied CKD-MBD models. As the hydroxyapatite of the long bones serves as a huge natural reservoir for Pi [48], low bone turnover may predispose the redistribution of Pi to non-skeletal tissues. Myocardium could be prone to Pi accumulation because of the ability of myocytes to accumulate high amounts of this anion, which is necessary to maintain their high-energy metabolism [49].…”