The role of phosphate in kidney disease

High phosphate concentrations are associated with an increased incidence of cardiovascular complications and mortality in the general population and in patients with chronic kidney disease (CKD)Serum phosphate concentrations are influenced by circadian rhythm and dietThe predictive value of a single serum phosphate measurement for cardiovascular risk is greatest for fasting morning concentrationsFibroblast growth factor 23 is a key hormone involved in phosphate homeostasis and an independent predictor of cardiovascular events with a potential causal role in the development of these eventsFrequently neglected sources of phosphate are bone in patients with CKD and food additives in all populationsDefinitive proof of a clinical benefit of dietary or pharmacological interventions that lower phosphate exposure is lacking, mainly owing to a paucity of well-designed clinical trials