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Phosphate may promote CKD progression and attenuate renoprotective effect of ACE inhibition

Carmine Zoccali1, Piero Ruggenenti, Annalisa Perna

  • 1Nephrology, Dialysis and Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy. carmine.zoccali@tin.it

Journal of the American Society of Nephrology : JASN
|August 20, 2011
PubMed

Insights

High phosphate levels accelerate chronic kidney disease progression and reduce the effectiveness of ACE inhibitors in patients with proteinuric kidney disease. Lowering phosphate may improve kidney outcomes.

Area of Science:

  • Nephrology
  • Endocrinology
  • Internal Medicine

Background:

  • Phosphate is implicated in the progression of chronic kidney disease (CKD).
  • The impact of serum phosphate on CKD progression and response to treatment is not fully understood.

Purpose of the Study:

  • To investigate the association between baseline serum phosphate levels and disease progression in patients with proteinuric nephropathies.
  • To evaluate how serum phosphate influences the renoprotective effects of angiotensin-converting enzyme (ACE) inhibition.

Main Methods:

  • Analysis of data from 331 patients in the prospective Ramipril Efficacy In Nephropathy (REIN) trial.
  • Assessment of relationships between baseline serum phosphate, disease progression (ESRD, doubling of serum creatinine), and response to ramipril.

Main Results:

  • Patients with higher serum phosphate levels exhibited significantly faster progression to end-stage renal disease (ESRD) or a composite endpoint.
  • The renoprotective effect of ramipril (an ACE inhibitor) diminished as serum phosphate levels increased.
  • This interaction persisted after adjusting for confounders like GFR and urinary protein.

Conclusions:

  • Serum phosphate is an independent risk factor for renal disease progression in proteinuric CKD.
  • Elevated phosphate levels may attenuate the renoprotective benefits of ACE inhibitors.
  • Further research is warranted to determine if phosphate reduction improves renal outcomes and enhances ACE inhibitor efficacy.

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