{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:54:35Z","timestamp":1791251675757,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Tenapanor, a minimally absorbed intestinal NHE3 inhibitor approved for hyperphosphatemia in dialysis, lowers phosphate and reduces intestinal sodium absorption. Its sodium\u2013water signal may have implications beyond phosphate but remains poorly separated from diarrhea\u2010mediated losses and dialysis prescription artifacts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This perspective synthesizes pharmacologic, trial, dialysis physiology, and CKD\u2010MBD evidence to propose a hypothesis\u2010generating framework for evaluating tenapanor beyond serum phosphate. We focused on intestinal sodium handling, stool transit, interdialytic weight gain, ultrafiltration stress, hemodynamic tolerance, and fibroblast growth factor 23.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Tenapanor\u2010associated diarrhea and modest serum sodium reduction should be interpreted not only as tolerability events but also as potential markers of on\u2010target intestinal sodium\u2013water modulation. In selected phenotypes, reduced effective sodium loading could theoretically attenuate thirst, lower interdialytic weight gain, and reduce ultrafiltration demand; in others, diarrhea\u2010mediated losses could worsen hypovolemia or intradialytic instability. Tenapanor\u2010induced fibroblast growth factor 23 reduction is biologically plausible but remains an unvalidated bridge to cardiovascular or patient\u2010centered outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Future studies should prospectively distinguish sodium\u2013volume benefit from gastrointestinal intolerance using standardized dialysis endpoints, stool metrics, dialysate sodium data, bioimpedance, and imaging or patient\u2010centered outcomes. Tenapanor should therefore be studied as an intestinal sodium\u2013phosphate\u2013volume intervention, not merely a phosphate\u2010lowering drug.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hdi.70095","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T03:55:17Z","timestamp":1780286117000},"page":"689-697","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tenapanor Beyond Phosphate: Gut Sodium Transport, Stool Transit Time, and Volume Balance in Dialysis Patients"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7247-4950","authenticated-orcid":false,"given":"Lucas Maciel de Almeida","family":"Corr\u00eaa","sequence":"first","affiliation":[{"name":"Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto (FAMERP)  S\u00e3o Jos\u00e9 do Rio Preto S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3774-604X","authenticated-orcid":false,"given":"Luiggi Kevin Virgino","family":"Brand\u00e3o","sequence":"additional","affiliation":[{"name":"Centro Universit\u00e1rio Uninorte (UNINORTE)  Rio Branco Acre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4791-4451","authenticated-orcid":false,"given":"Clara Belo Gamon","family":"Santiago","sequence":"additional","affiliation":[{"name":"Universidade Estadual de Mato Grosso do Sul (UEMS)  Campo Grande Mato Grosso do Sul Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3274-2319","authenticated-orcid":false,"given":"Alexandre de Assis","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Universidade Estadual de Mato Grosso do Sul (UEMS)  Campo Grande Mato Grosso do Sul Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5368-2901","authenticated-orcid":false,"given":"Gabriel Rian","family":"Mazur","sequence":"additional","affiliation":[{"name":"Pont\u00edficia Universidade Cat\u00f3lica Do Paran\u00e1 (PUCPR)  Curitiba Paran\u00e1 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8889-3117","authenticated-orcid":false,"given":"Gabriel Costa","family":"de Santana","sequence":"additional","affiliation":[{"name":"Universidade Salvador (UNIFACS)  Salvador Bahia Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6051-1808","authenticated-orcid":false,"given":"Yan Roberth Delmiro","family":"Silva","sequence":"additional","affiliation":[{"name":"Universidade Federal de Alagoas (UFAL)  Arapiraca Alagoas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3775-3350","authenticated-orcid":false,"given":"Let\u00edcia Esteves","family":"Dante","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto (FAMERP)  S\u00e3o Jos\u00e9 do Rio Preto S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8198-8434","authenticated-orcid":false,"given":"Ivan Felipe","family":"Dutra J\u00fanior","sequence":"additional","affiliation":[{"name":"Universidade Estadual de Mato Grosso do Sul (UEMS)  Campo Grande Mato Grosso do Sul Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/hdi.12315"},{"key":"e_1_2_16_3_1","volume-title":"XPHOZAH (Tenapanor) Tablets, for Oral Use: Prescribing Information","author":"US Food and Drug Administration","year":"2023"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40261\u2010017\u20100614\u20100"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3007790"},{"key":"e_1_2_16_6_1","volume-title":"Kyowa Kirin Announces Approval of PHOZEVEL for Improvement of Hyperphosphatemia in Chronic Kidney Disease Patients on Dialysis in Japan","author":"Kyowa Kirin Co. 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