Bone and mineral metabolism becomes dysregulated with progression of chronic kidney disease (CKD), and increasing levels of parathyroid hormone serve as an adaptive response to maintain normal phosphorus and calcium levels. In end-stage renal disease, this response becomes maladaptive and high levels of phosphorus may occur. We summarize strategies to control hyperphosphatemia based on a systematic literature review of clinical trial and real-world observational data on phosphorus control in hemodialysis patients with CKD-mineral bone disorder (CKD-MBD). These studies suggest that current management options (diet and lifestyle changes; regular dialysis treatment; and use of phosphate binders, vitamin D, calcimimetics) have their own benefits and limitations with variable clinical outcomes. A more integrated approach to phosphorus control in dialysis patients may be necessary, incorporating measurement of multiple biomarkers of CKD-MBD pathophysiology (calcium, phosphorus, and parathyroid hormone) and correlation between diet adjustments and CKD-MBD drugs, which may facilitate improved patient management.

随着慢性肾病 (CKD) 的进展，骨和矿物质代谢失调，甲状旁腺激素水平的增加作为维持正常磷和钙水平的适应性反应。在终末期肾病中，这种反应变得不适应并且可能出现高水平的磷。我们根据对患有 CKD-矿物质性骨病 (CKD-MBD) 的血液透析患者磷控制的临床试验和真实世界观察数据的系统文献回顾，总结了控制高磷血症的策略。这些研究表明，当前的管理选择（饮食和生活方式改变；定期透析治疗；使用磷酸盐结合剂、维生素 D、拟钙剂）有其自身的好处和局限性，临床结果各不相同。