The Central Role of Phosphate: 50 Years of Research and Discovery in Chronic Kidney Disease and Mineral & Bone Disorder

Round Table: defining new research priorities in CKD-MBD

Professor Sharon Moe

The meeting concluded with a round table discussion on potential clinical trial designs and preclinical studies, and development of other therapeutic targets. The general consensus was that placebocontrolled trials were needed in CKD stages 2-4 to investigate the effect of phosphate and phosphate binders on mortality.

Various other endpoints were suggested, such as bone disease, progression of CKD, and cardiovascular events. Ongoing studies investigating a broad range of cardiovascular surrogates are due for completion in 2011. Monitoring methods using the less expensive option of phosphate and creatinine were preferred over FGF- 23, which is expensive at present. The patient group was considered, and patients over 50/55 years of age with high levels of FGF-23 would provide the most valuable data.

Discussion of the development of other therapeutic targets included biomarkers, such as NaPi2a, b or c (to decrease the reabsorption of phosphate), but these were considered challenging targets; infusion of soluble klotho; how the bone senses phosphate; and why high levels of FGF-23 are found in non-renal organs. It was generally agreed that FGF-23 could be a uremic toxin, which may support development of anti-FGF-23 strategies in the future.