Phosphate - latest news and ongoing trials

Abstract Hyperphosphatemia is present in nearly all patients with kidney failure who receive maintenance dialysis. The direct toxicity of elevated phosphate concentrations had been inferred from basic experimentation and large epidemiologic studies. This has influenced clinical practice in which great efforts are expended in normalizing serum phosphate concentration. Targeted dietary strategies, optimization of dialysis and phosphate-lowering medications are all effective at lowering serum phosphate levels yet each pose challenges for patients and clinicians. The effect of these interventions, individually and collectively, on patient-centred clinical outcomes is also unclear. We will review the evidence from clinical trials for each of these measures and discuss ongoing research that is testing optimal targets for serum phosphate.