VIDEO: Understanding the relationship between CKD, hyperphosphatemia

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The kidneys, in addition to removing toxins, that creatinine number and filtration and things like that, the kidneys play a huge role in regulating electrolytes and acid base and fluid and sodium for the entire body. So with phosphorus, that's a substance that's ubiquitous in the foods that we eat. You know, traditionally phosphorus rich foods were dairy source foods, milk, cheese, ice creams, you know, those types of things.

But now the food industry has viewed a lot of phosphorus as a preservative. So you know, it enhances the shelf life. But the way it does that is that they incorporate a lot of phosphorus based substances into the food that sort of, like I said, acts as a preservative, which, you know, the problem there being is as we ingest that food, our stomachs and our intestines are 100% efficient at absorbing just about every molecule of phosphorus that you ingest. So, you know, there are certain substances that you know, after a certain while, you just can't absorb any more of these substances.

But the thing about phosphorus is that it's non-saturable. So every phosphorus molecule you eat is gonna get absorbed and the only way, the only way that the body gets rid of that phosphorus is through filtration of the kidneys. So, you know, as the kidney function drops, that phosphorus will tend to accumulate. Now our body does have some mechanisms to try to get rid of that extra phosphorus, but unfortunately that mechanism of trying to get rid of that extra phosphorus can hurt your bones. So it's a bit of a catch 22 there in terms of regulating that phosphorus and the problem with the high phosphorus that occurs in patients with chronic kidney disease is that negative charge of the phosphorus combines with a positive charge of calcium in your blood and starts to deposit inside the blood vessels, and when that happens, that's basically a trigger for narrowing of the blood vessels and subsequent Vascular Disease or Coronary Artery Disease.

So the higher the phosphorus, the more likely the patient is to develop coronary artery disease or vascular issues. So the association between CPD and Hyperphosphatemia is pretty strong. So, you know, we try to suggest things like dietary interventions of, you know, watching, you know dairy, watching your preservatives. There are certain substances, certain medications that we prescribe that sort of bind the phosphorus in our intestines and things like that. And there's some exciting new therapies there.

Speaking of new therapies as well, Tenapanor is one of the newer agents that may actually block the molecular mechanism of that phosphorus in the intestines. So that's something that's sort of coming down the pipe hopefully that may sort of help our patients even a little bit more for the prevention of coronary disease or vascular disease.