Importance of hyperphosphataemia in the cardio-renal axis.

Hyperphosphataemia occurs in nearly all patients with end-stage renal disease (ESRD). In the past, the need to manage hyperphosphataemia focused primarily on its role as a contributor to secondary hyperparathyroidism and renal osteodystrophy. There is now widespread recognition that disturbances in phosphorus metabolism and/or the therapeutic measures used to manage it are important risk factors for cardiovascular calcification. This serious complication of chronic kidney disease may contribute to the very high mortality rate from cardiovascular causes in patients undergoing long-term dialysis. New strategies for controlling serum phosphorus levels and for better management of mineral metabolism in general are required to address these issues in patients with ESRD.