Past, Present, and Future of Phosphate Management

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Pharmacology

Background:

• Cardiovascular disease (CVD) is the leading cause of death in dialysis patients.
• Elevated serum phosphorus is a significant risk factor for CVD and bone mineral disease in chronic kidney disease (CKD).
• Phosphate influences multiple CVD risk factors, including FGF-23 and parathyroid hormone.

Purpose of the Study:

• To highlight the challenges with current phosphate binder therapies.
• To introduce novel non-binder therapies for managing hyperphosphatemia.
• To emphasize the importance of phosphate control for improving cardiovascular health in CKD and end-stage kidney disease (ESKD).

Main Methods:

• Review of existing literature on hyperphosphatemia management in CKD.
• Discussion of the limitations and side effects of conventional phosphate binders.
• Introduction of emerging therapies targeting intestinal phosphate absorption pathways (e.g., EOS789, tenapanor).

Main Results:

• Current phosphate binders present challenges in adherence due to pill burden, taste, and gastrointestinal side effects.
• Most dialysis patients do not achieve target phosphorus levels (<5.5 mg/dl or <4.5 mg/dl).
• New therapies like EOS789 and tenapanor offer alternative mechanisms to reduce phosphate absorption.

Conclusions:

• Phosphate management remains a critical unmet need in CKD and ESKD patients.
• Novel approaches targeting intestinal phosphate absorption are essential for improving patient outcomes.
• Effective phosphate control is crucial for mitigating cardiovascular risk in this population.