Current Opinion in Nephrology and Hypertension最新文献_第3页

ANCA vasculitis: what is in the pipeline. ANCA血管炎：是什么在管道。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-09-01 Epub Date: 2026-05-15 DOI: 10.1097/MNH.0000000000001199

Abbal Koirala, Aditi Singh, Duvuru Geetha

{"title":"ANCA vasculitis: what is in the pipeline.","authors":"Abbal Koirala, Aditi Singh, Duvuru Geetha","doi":"10.1097/MNH.0000000000001199","DOIUrl":"10.1097/MNH.0000000000001199","url":null,"abstract":"Purpose of review: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is now recognized as a complex immune-mediated inflammatory disorder rather than a purely pauci-immune small-vessel vasculitis. Advances in understanding ANCA specificity, complement activation, neutrophil extracellular trap formation, genetic susceptibility, and environmental triggers have reshaped concepts of disease classification, prognosis, and therapy. A focused review of these developments is timely because they are directly informing current treatment strategies, disease stratification, and future drug development.Recent findings: Treatment has shifted from conventional cyclophosphamide and glucocorticoids toward targeted, steroid-sparing approaches. Rituximab is now central to remission induction and maintenance, while avacopan in GPA (granulomatosis with polyangiitis) and MPA (microscopic polyangiitis) and interleukin (IL)-5 blockade in EGPA (eosinophilic granulomatosis with polyangiitis) further reduce glucocorticoid exposure and toxicity. Emerging therapies include next-generation anti-CD20 monoclonal antibodies such as obinutuzumab, CAR-T cell strategies, and other precision immunologic approaches targeting B-cell pathways, including BAFF/APRIL blockade, tyrosine kinase inhibitors (TKIs) and complement-directed therapies designed to more selectively interrupt pathogenic inflammation.Summary: Improved biologic insight is enabling biomarker-driven classification and mechanism-based therapy selection. These advances may reduce treatment-related morbidity, improve durability of remission, and support a more personalized approach to clinical care and translational research in AAV.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"504-514"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Primary prevention of chronic kidney disease in type 2 diabetes mellitus with sodium-glucose cotransporter 2 inhibitors. 钠-葡萄糖共转运蛋白2抑制剂对2型糖尿病慢性肾病的一级预防作用

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-09-01 Epub Date: 2026-06-15 DOI: 10.1097/MNH.0000000000001205

Melanie Wanigatunga, Michael W Holliday, Sankar D Navaneethan

{"title":"Primary prevention of chronic kidney disease in type 2 diabetes mellitus with sodium-glucose cotransporter 2 inhibitors.","authors":"Melanie Wanigatunga, Michael W Holliday, Sankar D Navaneethan","doi":"10.1097/MNH.0000000000001205","DOIUrl":"10.1097/MNH.0000000000001205","url":null,"abstract":"Purpose of review: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have emerged as a transformative class of agents that provide significant kidney and cardiovascular protection for those with diabetic kidney disease. This review summarizes more recent data on the role of SGLT2is in the primary prevention of kidney disease in persons living with diabetes.Recent findings: Large randomized controlled trials consistently demonstrate that SGLT2i slow estimated glomerular filtration rate decline, reduce progression to end-stage kidney disease, and decrease kidney and cardiovascular mortality across a broad spectrum of participants with and without diabetes. Emerging evidence from secondary analyses of cardiovascular outcome trials and dedicated meta-analyses suggests that SGLT2i also reduce the incidence of new-onset chronic kidney disease (CKD) and albuminuria in participants with preserved kidney function, supporting a role in primary prevention.Summary: SGLT2 inhibitors represent a paradigm shift in nephrology, offering both preventive and disease-modifying effects and establishing a new foundation for CKD risk reduction in high-risk populations.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"498-503"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sex differences in renal acid-base regulation. 肾酸碱调节的性别差异。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-09-01 Epub Date: 2026-07-01 DOI: 10.1097/MNH.0000000000001207

Rebecca Zoe Halter, Jennifer Nogueira Coelho, Jessica A Dominguez Rieg, Timo Rieg

{"title":"Sex differences in renal acid-base regulation.","authors":"Rebecca Zoe Halter, Jennifer Nogueira Coelho, Jessica A Dominguez Rieg, Timo Rieg","doi":"10.1097/MNH.0000000000001207","DOIUrl":"10.1097/MNH.0000000000001207","url":null,"abstract":"Purpose of review: Sex-dependent differences are evident in most organs and contribute to variability in physiological function and disease susceptibility, which can consequently affect therapeutic responses. The kidney is no exception to this finding and recent data suggest that sexual dimorphism exists in the regulation of acid-base homeostasis.Recent findings: While proteins involved in the renal regulation of acid-base homeostasis have been characterized over several decades, researchers have only recently begun investigating how biological sex affects these processes. Although males and females handle acid-base challenges similarly in many respects, there are critical, sex-specific differences in how several key kidney proteins respond to these challenges. This review highlights those distinct differences, focusing specifically on proteins including: NHE3, NBC1, NKCC2, pT58 NCC, Rhbg, Rhcg, H + -ATPase, and Na + /K + -ATPase.Summary: Acid-base imbalances are among the most common and critical challenges in clinical medicine. Recent data reveal that female mice defend against systemic acid-base disruptions far more effectively than males, a resilience driven by distinct, sex-specific transport adaptations along the nephron. These findings underscore a critical gap in current care and the need for sex-specific therapeutic strategies in the clinical management of human acidosis and alkalosis.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"551-557"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13566383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

From K+ sensing to NCC on/off switching: KS-WNK1 as a spatial organizer of WNK signaling. 从K+感知到NCC开关：KS-WNK1作为WNK信号的空间组织者。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-09-01 Epub Date: 2026-06-25 DOI: 10.1097/MNH.0000000000001206

Laura Vergara, José A Cabrales-Alcaraz, Jessica Paola Bahena-López, María Chávez-Canales

{"title":"From K+ sensing to NCC on/off switching: KS-WNK1 as a spatial organizer of WNK signaling.","authors":"Laura Vergara, José A Cabrales-Alcaraz, Jessica Paola Bahena-López, María Chávez-Canales","doi":"10.1097/MNH.0000000000001206","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001206","url":null,"abstract":"Purpose of review: In the distal convoluted tubule (DCT), the NaCl cotransporter (NCC) regulates renal K+ homeostasis by controlling distal Na+ delivery. Although the kidney-specific WNK1 isoform kidney-specific with no lysine (k) kinase (KS-WNK1) is a key determinant of K+-dependent NCC responsiveness, divergent baseline phenotypes across murine alleles have obscured its core function. Here, we integrate evidence from heterologous systems and multiple mouse models to resolve these discrepancies and define a state-dependent role for KS-WNK1.Recent findings: Across K+ stress paradigms, KS-WNK1 promotes NCC activation during K+ depletion through assembly and apical positioning of WNK body condensates and enables efficient NCC shutdown during K+ repletion/excess, thereby expanding the dynamic range of K+-dependent NCC regulation.Summary: KS-WNK1 expands the dynamic range of K+-dependent NCC control by coupling spatial organization to signaling output in the distal nephron. Key open questions include how condensate positioning interfaces with apical NCC-regulatory microdomains and which phosphatase modules terminate signaling during refeeding, with implications for disordered Na+/K+ handling in hyperkalemia and hypertension.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"35 5","pages":"558-567"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Novel therapeutic approaches for phosphate regulation. 磷酸盐调节的新治疗方法。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-09-01 Epub Date: 2026-05-15 DOI: 10.1097/MNH.0000000000001191

Laith Alzyood, Wei Chen

{"title":"Novel therapeutic approaches for phosphate regulation.","authors":"Laith Alzyood, Wei Chen","doi":"10.1097/MNH.0000000000001191","DOIUrl":"10.1097/MNH.0000000000001191","url":null,"abstract":"Purpose of review: Hyperphosphatemia in chronic kidney disease (CKD) is associated with vascular calcification and increased mortality. Despite widespread use of phosphate binders, treatment of hyperphosphatemia remains challenging and controversy persists regarding the optimal serum phosphate targets. This review summarizes recent clinical and experimental studies of phosphate-lowering therapies in CKD.Recent findings: To define the optimal phosphate target, the Pragmatic Trial of Higher vs. Lower Serum Phosphate Targets in Patients Undergoing Hemodialysis (HiLo) trial was conducted but was terminated early and underpowered. Oxylanthanum carbonate is a new lanthanum-based agent with phosphate-binding efficacy equivalent to lanthanum carbonate but smaller in pill size. Tenapanor, an inhibitor of paracellular phosphate transport, effectively lowers serum phosphate and reduces pill burden. AP306, formerly known as EOS789, an inhibitor of active transcellular phosphate transporters, lowers serum phosphate more effectively compared to sevelamer carbonate. As with existing phosphate binders, gastrointestinal side effects are common with these new phosphate-lowering agents. Lastly, synbiotic therapy modulates gut microbiota and reduces intestinal phosphate absorption in rats with CKD.Summary: Combining phosphate binders with agents that inhibit paracellular and transcellular intestinal phosphate absorption may improve the treatment of hyperphosphatemia while reducing pill burden in CKD. Defining optimal serum phosphate targets and the mortality benefits of phosphate lowering is essential to minimize treatment-related adverse effects.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"491-497"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Novel developments in untangling the significance of Epac signaling in the kidney. 解开肾脏Epac信号意义的新进展。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-09-01 Epub Date: 2026-05-15 DOI: 10.1097/MNH.0000000000001198

Kyrylo Pyrshev, Oleg Zaika, Xiaodong Cheng, Oleh Pochynyuk

{"title":"Novel developments in untangling the significance of Epac signaling in the kidney.","authors":"Kyrylo Pyrshev, Oleg Zaika, Xiaodong Cheng, Oleh Pochynyuk","doi":"10.1097/MNH.0000000000001198","DOIUrl":"10.1097/MNH.0000000000001198","url":null,"abstract":"Purpose of review: Exchange proteins directly activated by cAMP (Epac1 and Epac2) are abundantly expressed in the glomerulus and epithelial cells of the renal tubule. Epac activity is rather benign at baseline, but it can be greatly potentiated in response to stress or during disease states. However, the significance of the Epac signaling cascade for kidney function is largely enigmatic. This review analyzes recently published evidence on the reno-protective actions of Epac1 and Epac2 isoforms in the pathology of glomerulonephritis and upon dietary acidification.Recent findings: Paralog-specific beneficial actions of Epac have been reported recently in the glomerulus and the collecting duct system. Activation of Epac1 promotes glycolysis and increases lactate production, thereby augmenting podocyte survival in an experimental model of glomerulonephritis. Dietary acidification greatly enhances renal Epac2, but not Epac1, expression to stimulate urinary acid excretion. Epac2 deficiency produces a distal renal tubule acidosis (RTA)-like phenotype associated with the inability to acidify urine due to impaired H + secretion by A-type intercalated cells.Summary: Activation of Epac1 and Epac2 isoforms is instrumental for defensive and adaptive responses in the pathophysiology of glomerulonephritis and metabolic acidosis. Further characterization and subsequent implementation of pharmacology-based treatments targeting individual Epac isoforms might be of considerable clinical importance.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"545-550"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The role of kir4.1/Kir5.1 in mediating the effect of angiotensin-II on Na-Cl-cotransporter. kir4.1/Kir5.1在介导血管紧张素- ii对na - cl -共转运蛋白影响中的作用。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-09-01 Epub Date: 2026-06-03 DOI: 10.1097/MNH.0000000000001203

Wen-Hui Wang, Dao-Hong Lin

{"title":"The role of kir4.1/Kir5.1 in mediating the effect of angiotensin-II on Na-Cl-cotransporter.","authors":"Wen-Hui Wang, Dao-Hong Lin","doi":"10.1097/MNH.0000000000001203","DOIUrl":"10.1097/MNH.0000000000001203","url":null,"abstract":"Purpose of review: Angiotensin-II plays an important role in regulating thiazide-sensitive Na-Cl-cotransporter (NCC) encoded by Slc12A3. Moreover, inwardly-rectifying-K + (Kir) channels 4.1/Kir5.1 encoded by Kcnj10 and Kcnj16 have been shown to determine NCC expression/activity. This review discusses the role of Kir4.1/Kir5.1 of distal-convoluted-tubule (DCT) in mediating the effect of angiotensin-II on NCC expression/activity.Recent findings: Deletion of kidney-tubule AT1aR has no significant effect on baseline-activity of Kir4.1/Kir5.1 of DCT. However, angiotensin-II acutely stimulates Kir4.1/Kir5.1-activity and hyperpolarizes basolateral membrane predominantly in the late DCT but not in early-DCT. Angiotensin-II perfusion for 24-h stimulates NCC expression/activity, this effect is absent in kidney-tubule-specific Kir4.1-knockout mice. However, angiotensin-II perfusion for 7-days is still able to increase NCC expression/activity in kidney-tubule-specific Kir4.1-knockout mice. The deletion of AT1aR completely abolishes both short-term and long-term effects of angiotensin-II on NCC. Overnight-low-salt intake stimulates Kir4.1/Kir5.1 in DCT and NCC in wild-type mice. This effect is absent in AT1aR-knockout mice and overnight-low-salt increases renal-K + -excretion in AT1aR-knockout mice.Summary: AT1aR is not required for baseline-activity of Kir4.1/Kir5.1 but it mediates the Ang-II and the effect of low-salt-intake on Kir4.1/Kir5.1. Short-term Ang-II-induced stimulation of NCC requires Kir4.1/Kir5.1. However, Ang-II also stimulates NCC by Kir4.1/Kir5.1-independent mechanism. AT1aR plays a role in maintaining K + homeostasis during low-salt-intake.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"576-581"},"PeriodicalIF":3.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Parathyroid hormone levels: the lower the better the outcomes. 甲状旁腺激素水平：越低效果越好。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-07-01 Epub Date: 2026-04-30 DOI: 10.1097/MNH.0000000000001188

Hirotaka Komaba

{"title":"Parathyroid hormone levels: the lower the better the outcomes.","authors":"Hirotaka Komaba","doi":"10.1097/MNH.0000000000001188","DOIUrl":"10.1097/MNH.0000000000001188","url":null,"abstract":"Purpose of review: Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease, particularly in patients receiving dialysis. Conventional management has emphasized avoiding excessively low PTH levels to prevent low-turnover bone disease, yet recent evidence challenges this approach. This review examines the potential of more intensive PTH control to improve skeletal and clinical outcomes.Recent findings: Although excessive suppression of PTH or low-turnover bone has been thought to impair bone strength, recent evidence indicates that intensive PTH reduction does not compromise bone integrity and may even reduce fracture risk. PTH-lowering interventions appear to limit further progression of SHPT-associated cortical porosity but cannot reverse established structural damage, underscoring the importance of early intervention. Low-turnover bone has also been hypothesized to impair calcium buffering and promote vascular calcification; however, its clinical impact seems limited in the era of widespread calcimimetic use or following parathyroidectomy. Furthermore, there is no clear evidence that excessive PTH suppression adversely affects nonskeletal organs influenced by SHPT.Summary: These findings suggest that the benefits of more intensive PTH control may outweigh potential risks, supporting a proactive management approach. Prospective interventional studies are needed to confirm whether this strategy can reduce fractures and improve survival without safety concerns.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"427-432"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Remission in diabetic kidney disease: current evidence and future directions. 糖尿病肾病的缓解：目前的证据和未来的方向。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-07-01 Epub Date: 2026-05-03 DOI: 10.1097/MNH.0000000000001197

Michael Reaume, Navdeep Tangri

{"title":"Remission in diabetic kidney disease: current evidence and future directions.","authors":"Michael Reaume, Navdeep Tangri","doi":"10.1097/MNH.0000000000001197","DOIUrl":"10.1097/MNH.0000000000001197","url":null,"abstract":"Purpose of review: Diabetes is the leading cause of chronic kidney disease (CKD) worldwide. Diabetic kidney disease (DKD) has traditionally been viewed as a progressive condition characterized by declining estimated glomerular filtration rate (eGFR) and worsening albuminuria, with affected individuals facing substantially elevated risks of major adverse cardiovascular events and kidney failure. However, recent advances in pharmacologic therapies have demonstrated dramatic improvements in both cardiovascular and kidney outcomes. The objective of this review is to summarize the evidence for contemporary pharmacologic therapies in DKD, and to examine the emerging concept of disease remission in DKD.Recent findings: Randomized controlled trials of sodium-glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists have demonstrated significant attenuation of eGFR decline and reductions in albuminuria. These findings have given rise to the hypothesis that, with guideline-directed therapy, some patients with DKD may achieve disease remission, defined by physiologic declines in eGFR and minimal (or resolved) albuminuria. Emerging evidence not only highlights the promise of this paradigm but also underscores the lack of standardized definitions and long-term outcome data.Summary: Emerging pharmacologic therapies are transforming DKD. Reframing DKD management from one of slowing progression to achieving remission could have important implications for clinical practice worldwide.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"480-489"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Recent insights into the role of dietary phosphorus in the development and progression of chronic kidney disease-mineral and bone disorder. 膳食磷在慢性肾脏疾病-矿物质和骨骼疾病的发生和进展中的作用的最新见解。

IF 3.1 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2026-07-01 Epub Date: 2026-04-30 DOI: 10.1097/MNH.0000000000001185

Orlando M Gutiérrez

{"title":"Recent insights into the role of dietary phosphorus in the development and progression of chronic kidney disease-mineral and bone disorder.","authors":"Orlando M Gutiérrez","doi":"10.1097/MNH.0000000000001185","DOIUrl":"10.1097/MNH.0000000000001185","url":null,"abstract":"Purpose of review: Dietary phosphorus is a central driver of chronic kidney disease-mineral and bone disorder (CKD-MBD). This review summarizes recent advances that clarify how differing forms and sources of dietary phosphorus influence bone and mineral metabolism, as well as related physiologic outcomes, in individuals with and without CKD.Recent findings: Controlled feeding studies across CKD and non-CKD populations demonstrate that reducing intake of highly bioavailable phosphorus - particularly from food additives - leads to consistent improvements in urinary phosphorus excretion, fibroblast growth factor 23, parathyroid hormone, and α-Klotho levels, with more pronounced benefits among individuals with CKD. Higher consumption of whole-grain phosphorus, which is less bioavailable, has been associated with lower cardiovascular and all-cause mortality risk and does not appear to adversely affect mineral metabolism in CKD. Additional population-based, physiologic, and translational studies further show that intake of added or highly bioavailable phosphorus is linked to greater adiposity, impaired mitochondrial ATP production, and abnormal mitochondrial responses during exercise. These observations suggest that bioavailable phosphorus has systemic metabolic effects extending beyond traditional CKD-MBD pathways.Summary: Highly bioavailable phosphorus additives disrupt mineral metabolism and contribute to broader metabolic dysfunction, supporting the need for updated dietary recommendations and further mechanistic and clinical investigation.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"447-452"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0