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Wagner CA. The basics of phosphate metabolism. Nephrol Dial Transplant 2024; 39:190-201. [PMID: 37660247 PMCID: PMC10828206 DOI: 10.1093/ndt/gfad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 09/04/2023] Open
Abstract
Phosphorus is an essential mineral that is, in the form of inorganic phosphate (Pi), required for building cell membranes, DNA and RNA molecules, energy metabolism, signal transduction and pH buffering. In bone, Pi is essential for bone stability in the form of apatite. Intestinal absorption of dietary Pi depends on its bioavailability and has two distinct modes of active transcellular and passive paracellular absorption. Active transport is transporter mediated and partly regulated, while passive absorption depends mostly on bioavailability. Renal excretion controls systemic Pi levels, depends on transporters in the proximal tubule and is highly regulated. Deposition and release of Pi into and from soft tissues and bone has to be tightly controlled. The endocrine network coordinating intestinal absorption, renal excretion and bone turnover integrates dietary intake and metabolic requirements with renal excretion and is critical for bone stability and cardiovascular health during states of hypophosphataemia or hyperphosphataemia as evident from inborn or acquired diseases. This review provides an integrated overview of the biology of phosphate and Pi in mammals.
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Affiliation(s)
- Carsten A Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland
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Abstract
Phosphate is essential in living organisms and its blood levels are regulated by a complex network involving the kidneys, intestine, parathyroid glands, and the skeleton. The crosstalk between these organs is executed primarily by three hormones, calcitriol, parathyroid hormone, and fibroblast growth factor 23. Largely due to a higher intake of ultraprocessed foods, dietary phosphate intake has increased in the last decades. The average intake is now about twice the recommended dietary allowance. Studies investigating the side effect of chronic high dietary phosphate intake suffer from incomplete dietary phosphate assessment and, therefore, often make data interpretation difficult. Renal excretion is quickly adapted to acute and chronic phosphate intake. However, at the high ends of dietary intake, renal adaptation, even in pre-existing normal kidney function, apparently is not perfect. Experimental intervention studies suggest that chronic excess of dietary phosphate can result in sustained higher blood phosphate leading to hyperphosphatemia. Evidence exists that the price of the homeostatic response (phosphaturia in response to phosphate loading/hyperphosphatemia) is an increased risk for declining kidney function, partly due by intraluminal/tubular calcium phosphate particles that provoke renal inflammation. High dietary phosphate intake and hyperphosphatemia are progression factors for declining kidney function and are associated with higher cardiovascular disease and mortality risk. This is best established for pre-existing chronic kidney disease, but epidemiological and experimental data strongly suggest that this holds true for subjects with normal renal function as well. Here, we review the latest advances in phosphate intake and kidney function decline.
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Affiliation(s)
- Isabel Rubio-Aliaga
- Institute of Physiology, National Center of Competence in Research NCCR Kidney.CH, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
| | - Reto Krapf
- Synlab Suisse, 6002, Lucerne, Switzerland
- Department of Medicine, University of Basel, 4056, Basel, Switzerland
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Richter B, Kapanadze T, Weingärtner N, Walter S, Vogt I, Grund A, Schmitz J, Bräsen JH, Limbourg FP, Haffner D, Leifheit-Nestler M. High phosphate-induced progressive proximal tubular injury is associated with the activation of Stat3/Kim-1 signaling pathway and macrophage recruitment. FASEB J 2022; 36:e22407. [PMID: 35713543 DOI: 10.1096/fj.202200167rr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 12/11/2022]
Abstract
Dietary phosphate intake in the Western population greatly exceeds the recommended dietary allowance and is linked to enhanced cardiovascular and all-cause mortality. It is unclear whether a chronic high phosphate diet (HPD) causes kidney injury in healthy individuals. Here, we show that feeding a 2% HPD in C57BL/6N mice for one up to six months resulted in hyperphosphatemia, hyperphosphaturia, increased plasma levels of fibroblast growth factor (FGF) 23, and parathyroid hormone (PTH) compared to mice on a 0.8% phosphate diet. Kidney injury was already noted after two months of HPD characterized by loss of proximal tubular (PT) cell polarity, flattened epithelia, disruption of brush border membranes, vacuolization, increased PT cell proliferation, marked interstitial mononuclear infiltration, and progressive accumulation of collagen fibers. HPD increased Stat3 activation and Kim-1 expression in PT epithelial cells and enhanced renal synthesis of chemokines recruiting monocytes and macrophages as well as macrophage related factors. Enhanced recruitment of F4/80+ macrophages around injured PT lesions was timely associated with increased Kim-1 synthesis, tubular MCP-1 expression, and degree of PT injury score. Likewise, tubulointerstitial fibrosis was associated with activation of Stat3/Kim-1 signaling pathway. The stimulation of human proximal tubular cells with high phosphate activated Stat3 signaling and induced HAVCR1 and CCL2 expression. We conclude that high phosphate results in progressive proximal tubular injury, indicating that high dietary phosphate intake may affect kidney health and therefore represents an underestimated health problem for the general population.
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Affiliation(s)
- Beatrice Richter
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hannover, Germany
| | - Tamar Kapanadze
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Vascular Medicine Research, Hannover Medical School, Hannover, Germany
| | - Nina Weingärtner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hannover, Germany
| | - Stefanie Walter
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hannover, Germany
| | - Isabel Vogt
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hannover, Germany
| | - Andrea Grund
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hannover, Germany
| | - Jessica Schmitz
- Institute of Pathology, Nephropathology Unit, Hannover Medical School, Hannover, Germany
| | - Jan Hinrich Bräsen
- Institute of Pathology, Nephropathology Unit, Hannover Medical School, Hannover, Germany
| | - Florian P Limbourg
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Vascular Medicine Research, Hannover Medical School, Hannover, Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hannover, Germany
| | - Maren Leifheit-Nestler
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Pediatric Research Center, Hannover Medical School, Hannover, Germany
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Vidal P, Baer LA, Félix-Soriano E, Yang FT, Branch DA, Baskin KK, Stanford KI. Distinct Effects of High-Fat and High-Phosphate Diet on Glucose Metabolism and the Response to Voluntary Exercise in Male Mice. Nutrients 2022; 14:nu14061201. [PMID: 35334860 PMCID: PMC8951123 DOI: 10.3390/nu14061201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
The prevalence of metabolic diseases is rapidly increasing and a principal contributor to this is diet, including increased consumption of energy-rich foods and foods with added phosphates. Exercise is an effective therapeutic approach to combat metabolic disease. While exercise is effective to combat the detrimental effects of a high-fat diet on metabolic health, the effects of exercise on a high-phosphate diet have not been thoroughly investigated. Here, we investigated the effects of a high-fat or high-phosphate diet in the presence or absence of voluntary exercise on metabolic function in male mice. To do this, mice were fed a low-fat, normal-phosphate diet (LFPD), a high-phosphate diet (HPD) or a high-fat diet (HFD) for 6 weeks and then subdivided into either sedentary or exercised (housed with running wheels) for an additional 8 weeks. An HFD severely impaired metabolic function in mice, increasing total fat mass and worsening whole-body glucose tolerance, while HPD did not induce any notable effects on glucose metabolism. Exercise reverted most of the detrimental metabolic adaptations induced by HFD, decreasing total fat mass and restoring whole-body glucose tolerance and insulin sensitivity. Interestingly, voluntary exercise had a similar effect on LFPD and HPD mice. These data suggest that a high-phosphate diet does not significantly impair glucose metabolism in sedentary or voluntary exercised conditions.
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Ugrica M, Gehring N, Giesbertz P, Pastor-Arroyo EM, Daniel H, Wagner CA, Rubio-Aliaga I. Chronic High Phosphate Intake in Mice Affects Macronutrient Utilization and Body Composition. Mol Nutr Food Res 2022; 66:e2100949. [PMID: 35194921 DOI: 10.1002/mnfr.202100949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/04/2022] [Indexed: 11/11/2022]
Abstract
SCOPE In the last decades, dietary phosphate intake has increased due to a higher consumption of processed food. This higher intake has an impact on body composition and health state. Recently, we found that a high chronic phosphate diet leads to no major renal alterations, but negatively affects parameters of bone health probably due to the chronic acid load. Here we assessed the effect of high phosphate consumption on parameters of energy metabolism. METHODS AND RESULTS Healthy mature adult mice were fed for 1 year or four months with either a standard (0.6 % w/w) or a high phosphate (1.2 % w/w) diet. Males and females of two different genetic backgrounds were investigated. Mice fed the high phosphate diet showed an attenuated body-weight gain, lower respiratory exchange ratio, decreased body fat mass and increased lean-to-fat mass ratio. Moreover, the high phosphate diet led to fasting hypoglycemia with no differences in the glucose response to an oral glucose tolerance test. Triglycerides and cholesterol in blood were similar independently of dietary phosphate content. However, 1-methylhistidine was lower in animals fed a chronic high phosphate intake. CONCLUSIONS High phosphate diet attenuates body weight gain, but induces hypoglycaemia and may alter muscle homeostasis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marko Ugrica
- Institute of Physiology, University of Zurich, and National Center of Competence in Research NCCR Kidney, Zurich, 8057, Switzerland
| | - Nicole Gehring
- Institute of Physiology, University of Zurich, and National Center of Competence in Research NCCR Kidney, Zurich, 8057, Switzerland
| | - Pieter Giesbertz
- Nutritional Physiology, Technical University of Munich, Freising, 85354, Germany
| | - Eva-Maria Pastor-Arroyo
- Institute of Physiology, University of Zurich, and National Center of Competence in Research NCCR Kidney, Zurich, 8057, Switzerland
| | - Hannelore Daniel
- Nutritional Physiology, Technical University of Munich, Freising, 85354, Germany
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, and National Center of Competence in Research NCCR Kidney, Zurich, 8057, Switzerland
| | - Isabel Rubio-Aliaga
- Institute of Physiology, University of Zurich, and National Center of Competence in Research NCCR Kidney, Zurich, 8057, Switzerland
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Czaya B, Heitman K, Campos I, Yanucil C, Kentrup D, Westbrook D, Gutierrez O, Babitt JL, Jung G, Salusky IB, Hanudel M, Faul C. Hyperphosphatemia increases inflammation to exacerbate anemia and skeletal muscle wasting independently of FGF23-FGFR4 signaling. eLife 2022; 11:74782. [PMID: 35302487 PMCID: PMC8963881 DOI: 10.7554/elife.74782] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Elevations in plasma phosphate concentrations (hyperphosphatemia) occur in chronic kidney disease (CKD), in certain genetic disorders, and following the intake of a phosphate-rich diet. Whether hyperphosphatemia and/or associated changes in metabolic regulators, including elevations of fibroblast growth factor 23 (FGF23) directly contribute to specific complications of CKD is uncertain. Here, we report that similar to patients with CKD, mice with adenine-induced CKD develop inflammation, anemia, and skeletal muscle wasting. These complications are also observed in mice fed high phosphate diet even without CKD. Ablation of pathologic FGF23-FGFR4 signaling did not protect mice on an increased phosphate diet or mice with adenine-induced CKD from these sequelae. However, low phosphate diet ameliorated anemia and skeletal muscle wasting in a genetic mouse model of CKD. Our mechanistic in vitro studies indicate that phosphate elevations induce inflammatory signaling and increase hepcidin expression in hepatocytes, a potential causative link between hyperphosphatemia, anemia, and skeletal muscle dysfunction. Our study suggests that high phosphate intake, as caused by the consumption of processed food, may have harmful effects irrespective of pre-existing kidney injury, supporting not only the clinical utility of treating hyperphosphatemia in CKD patients but also arguing for limiting phosphate intake in healthy individuals.
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Affiliation(s)
- Brian Czaya
- Division of Nephrology and Hypertension, Department of Medicine, The University of Alabama at BirminghamBirminghamUnited States,Department of Medicine, David Geffen School of Medicine at UCLALos AngelesUnited States
| | - Kylie Heitman
- Division of Nephrology and Hypertension, Department of Medicine, The University of Alabama at BirminghamBirminghamUnited States
| | - Isaac Campos
- Division of Nephrology and Hypertension, Department of Medicine, The University of Alabama at BirminghamBirminghamUnited States
| | - Christopher Yanucil
- Division of Nephrology and Hypertension, Department of Medicine, The University of Alabama at BirminghamBirminghamUnited States
| | - Dominik Kentrup
- Division of Nephrology and Hypertension, Department of Medicine, The University of Alabama at BirminghamBirminghamUnited States
| | - David Westbrook
- Division of Nephrology and Hypertension, Department of Medicine, The University of Alabama at BirminghamBirminghamUnited States
| | - Orlando Gutierrez
- Division of Nephrology and Hypertension, Department of Medicine, The University of Alabama at BirminghamBirminghamUnited States
| | - Jodie L Babitt
- Division of Nephrology, Program in Membrane Biology, Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
| | - Grace Jung
- Department of Medicine, David Geffen School of Medicine at UCLALos AngelesUnited States
| | - Isidro B Salusky
- Department of Pediatrics, David Geffen School of Medicine at UCLALos AngelesUnited States
| | - Mark Hanudel
- Department of Pediatrics, David Geffen School of Medicine at UCLALos AngelesUnited States
| | - Christian Faul
- Division of Nephrology and Hypertension, Department of Medicine, The University of Alabama at BirminghamBirminghamUnited States
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Gutiérrez OM. Recent Advances in the Role of Diet in Bone and Mineral Disorders in Chronic Kidney Disease. Curr Osteoporos Rep 2021; 19:574-579. [PMID: 34729692 PMCID: PMC8720074 DOI: 10.1007/s11914-021-00710-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Chronic kidney disease mineral and bone disease (CKD-MBD) is a common complication of kidney disease and is strongly influenced by diet. The purpose of this manuscript is to review recent advances in the role of diet in CKD-MBD over the last 5 years. RECENT FINDINGS Many of the recent studies examining the role of diet in CKD-MBD have focused on the adverse effects of high phosphorus consumption on bone health and metabolism. In general, the studies have shown that high phosphorus consumption worsens markers of bone and mineral metabolism but that eating a diet with a calcium to phosphorus ratio closer to 1:1 can attenuate some of these effects. Recent studies also showed that dietary counseling is efficacious for improving markers of CKD-MBD. High consumption of phosphorus aggravates CKD-MBD. Dietary counseling may ameliorate these effects, for example, by consuming diets with higher calcium to phosphorus ratios.
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Affiliation(s)
- Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, THT 647, 1720 2nd AVE S, Birmingham, AL, 35294-0006, USA.
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, THT 647, 1720 2nd AVE S, Birmingham, AL, 35294-0006, USA.
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Figueres L, Beck-Cormier S, Beck L, Marks J. The Complexities of Organ Crosstalk in Phosphate Homeostasis: Time to Put Phosphate Sensing Back in the Limelight. Int J Mol Sci 2021; 22:5701. [PMID: 34071837 PMCID: PMC8199323 DOI: 10.3390/ijms22115701] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022] Open
Abstract
Phosphate homeostasis is essential for health and is achieved via interaction between the bone, kidney, small intestine, and parathyroid glands and via intricate processes involving phosphate transporters, phosphate sensors, and circulating hormones. Numerous genetic and acquired disorders are associated with disruption in these processes and can lead to significant morbidity and mortality. The role of the kidney in phosphate homeostasis is well known, although it is recognized that the cellular mechanisms in murine models and humans are different. Intestinal phosphate transport also appears to differ in humans and rodents, with recent studies demonstrating a dominant role for the paracellular pathway. The existence of phosphate sensing has been acknowledged for decades; however, the underlying molecular mechanisms are poorly understood. At least three phosphate sensors have emerged. PiT2 and FGFR1c both act as phosphate sensors controlling Fibroblast Growth Factor 23 secretion in bone, whereas the calcium-sensing receptor controls parathyroid hormone secretion in response to extracellular phosphate. All three of the proposed sensors are expressed in the kidney and intestine but their exact function in these organs is unknown. Understanding organ interactions and the mechanisms involved in phosphate sensing requires significant research to develop novel approaches for the treatment of phosphate homeostasis disorders.
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Affiliation(s)
- Lucile Figueres
- Department of Neuroscience, Physiology and Pharmacology, Royal Free Campus, University College London, London NW3 2PF, UK;
- CHU de Nantes, Université de Nantes, F-44042 Nantes, France
| | - Sarah Beck-Cormier
- Inserm, UMR 1229, RMeS Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, F-44042 Nantes, France; (S.B.-C.); (L.B.)
| | - Laurent Beck
- Inserm, UMR 1229, RMeS Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, F-44042 Nantes, France; (S.B.-C.); (L.B.)
| | - Joanne Marks
- Department of Neuroscience, Physiology and Pharmacology, Royal Free Campus, University College London, London NW3 2PF, UK;
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