Phosphate and cardiovascular disease

Adv Chronic Kidney Dis. 2011 Mar;18(2):113-9. doi: 10.1053/j.ackd.2010.12.003.


Hyperphosphatemia is a major risk factor for death, CVE, and vascular calcification among patients with and without kidney disease. Even serum phosphate levels within the "normal laboratory range" associate with a greater risk of death and CVE. Potential mechanisms by which increased phosphate results in adverse outcomes are not fully understood, but current evidence suggests a direct effect of phosphate on vascular calcification and modulation of key hormones fibroblast growth factor-23 and calcitriol. Despite convincing epidemiologic connections between phosphate excess and cardiovascular disease, no clinical trials have been conducted to establish a causal relationship, and large, randomized trials with hard endpoints are urgently needed to prove or disprove the benefits and risks of therapy.

Publication types

  • Review

MeSH terms

  • Calcinosis / metabolism
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / metabolism*
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / metabolism
  • Homeostasis
  • Humans
  • Phosphates / blood*
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / metabolism*
  • Renal Insufficiency, Chronic / physiopathology*
  • Renal Insufficiency, Chronic / therapy
  • Risk Factors
  • Vitamin D / metabolism


  • Phosphates
  • Vitamin D
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23