In a study of 331 patients with proteinuric nephropathies, Carmine Zoccali, MD, and colleagues report in Journal of the American Society of Nephrology that those with phosphate levels in the highest two quartiles progressed significantly faster either to end-stage renal disease (ESRD) or to a composite endpoint of a doubling of serum creatinine or ESRD compared with patients with phosphate levels below the median, independent of treatment.

The renoprotective effect of ramipril decreased as serum phosphate increased.