Phosphorus and Cardiovascular System

Several factors play an important role in the pathogenesis of cardiovascular disease (CVD) in chronic kidney disease (CKD) patients. Among these the phosphatemia play a crucial role. In CKD patients the phosphatemia (P) levels increase as a consequence of decreased renal elimination.The dramatical effect of phosphatemia on cardiovascular system is mediated by P stimulation on the synthesis of Fibroblast Growth Factor-23 (FGF-23). FGF-23 in turn stimulates the angiotensin converting enzyme (ACE) and accordingly the reninangiotensin- aldosterone system (RAAS). The RAAS stimulation exceeds the positive reno-protective effect of Ramipril especially at the tissue level. Moreover P reduces the nitric oxide (NO) production, directly or by FGF-23, and in this way P reduces the ACE inhibitor effects. In this paper we review the main effects of mineral metabolism disturbances on CVD particularly focusing on P effects.