Phosphorus and Cardiovascular System

Mini Review

Austin J Nephrol Hypertens. 2015;2(3): 1041.

Phosphorus and Cardiovascular System

Barbera V*, Gorini A and Di Lullo L

Department of Nephrology and Dialysis, Colleferro County Hospital, Italy

*Corresponding author: Vincenzo Barbera, Department of Nephrology and Dialysis, Colleferro County Hospital, Piazza Aldo Moro, 1 Colleferro, Rome, Italy

Received: July 02, 2015; Accepted: August 07, 2015; Published: August 10, 2015


Several factors play an important role in the pathogenesis of cardiovascular disease (CVD) in chronic kidney disease (CKD) patients. Among these the phosphatemia play a crucial role. In CKD patients the phosphatemia (P) levels increase as a consequence of decreased renal elimination.The dramatical effect of phosphatemia on cardiovascular system is mediated by P stimulation on the synthesis of Fibroblast Growth Factor-23 (FGF-23). FGF-23 in turn stimulates the angiotensin converting enzyme (ACE) and accordingly the reninangiotensin- aldosterone system (RAAS). The RAAS stimulation exceeds the positive reno-protective effect of Ramipril especially at the tissue level. Moreover P reduces the nitric oxide (NO) production, directly or by FGF-23, and in this way P reduces the ACE inhibitor effects.

In this paper we review the main effects of mineral metabolism disturbances on CVD particularly focusing on P effects.

Keywords: Phosphatemia; Cardiovascular System; Chronic Kidney Disease


Chronic Kidney Disease (CKD) is a relevant public health problem in industrialized countries.

American epidemiological data published in the study NANHES IV show that a 13% of population has a CKD in each stage of disease [1].

In Europe we observe prevalence data smaller than the US (e.g.11, 6% in Holland and 9% in Spain) [1].

In Italy we have conflicting data: the two most representative studies, Gubbio and INCIPE, show a CKD prevalence of 6% and 12, 7% respectively.

In the clinical perspective, the CKD patients have a higher risk for death and cardiovascular disease (CVD) than general population. The CVD risk increases directly with the CKD progression [2].

CVD Risk Factor and CKD: the role of Phosphorus

Several factors play a role in CVD pathogenesis in CKD patients. Stevinkel has evaluated all traditional risk factors (age, gender, dyslipidemia, blood hypertension, diabetes and smoking), known from the Framingham study, and has added endothelial dysfunction and inflammatory markers including the presence of secondary hyperparathyroidism (SHPT) that is a common condition in CKD cohort [3] (Figure 1).