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  3. Vol. 13 No. 1 (2025): Continuous 2025
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Vol. 13 No. 1 (2025)

May 2026

The Critical Role and Therapeutic Necessity of Hypophosphatemic Formulations in Pediatric Chronic Kidney Disease Hypophosphatemic Formulations in CKD

  • Nahid Rahimzadeh
  • Hasan Esfandyari
  • Fatemeh Ghanbarian
  • Nadereh Nassiri
  • Faranak Parastegari
  • Shadi Pourmand
  • Pardis Aghaei
  • Mohammad Mohammadi
  • Mahdieh Shafiei
  • Mastaneh Moghtaderi

Journal of Pediatric Nephrology, Vol. 13 No. 1 (2025), 12 May 2026
https://doi.org/10.22037/jpn.v13i1.49430 Published: 2026-05-12

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Abstract

Pediatric chronic kidney disease (CKD) represents a complex and evolving clinical entity with
profound implications for long-term morbidity and quality of life. Unlike adult CKD, where
the therapeutic focus often centers on dialysis adequacy and cardiovascular comorbidities,
pediatric CKD care necessitates a developmentally sensitive and growth-oriented approach.
One of the most critical, yet under-recognized, metabolic complications in this population is
persistent hyperphosphatemia—a state of phosphate overload that exerts pathophysiological
effects across skeletal, cardiovascular, endocrine, and neurological systems.
Phosphate is essential for multiple physiological processes, including skeletal mineralization,
energy metabolism via ATP synthesis, cellular signaling pathways, and the regulation
of acid-base balance. These specialized formulas
are designed to meet growing children’s full caloric, protein, and micronutrient needs while
minimizing the intake of inorganic and highly absorbable phosphate. This systematic review
explored the biochemical basis and clinical relevance of phosphate dysregulation in pediatric
CKD, delineated its systemic complications with an emphasis on growth and bone health,
and critically appraised the emerging role of hypophosphatemic formulas as a cornerstone therapeutic intervention. It synthesized findings from the current international clinical
guidelines—including KDIGO, KDOQI, and ESPEN—while identifying critical gaps in
pediatric-specific evidence. Moreover, it discussed the practical aspects of implementing
hypophosphatemic strategies, such as regional availability, cultural adaptability, formulation
palatability, and caregiver education.

Keywords:
  • Hyperphosphatemia
  • Chronic kidney disease (CKD)
  • Formula
  • Renal osteodystrophy
  • FGF-23
  • Secondary hyperparathyroidism
  • Children
  • pdf

How to Cite

1.
Rahimzadeh N, Esfandyari H, Ghanbarian F, Nassiri N, Parastegari F, Pourmand S, et al. The Critical Role and Therapeutic Necessity of Hypophosphatemic Formulations in Pediatric Chronic Kidney Disease: Hypophosphatemic Formulations in CKD. J Ped Nephrol [Internet]. 2026 May 12 [cited 2026 Jul. 8];13(1). Available from: https://journals.sbmu.ac.ir/jpn/article/view/49430
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