{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:46:24Z","timestamp":1791996384398,"version":"4.4.0"},"reference-count":72,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nephron"],"abstract":"<jats:p>Background: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a major contributor to cardiovascular mortality in CKD patients, with vascular calcification (VC) as a key predictor of adverse outcomes. Current phosphate management effectively lowers serum phosphate but fails to halt VC progression, highlighting a fundamental limitation of relying solely on serum phosphate monitoring. The underlying mechanisms linking phosphate control to calcification remain incompletely understood, and specific guidance for integrating novel therapeutic strategies is lacking. Summary: This narrative review synthesizes evidence from mechanistic studies and clinical trials (PubMed, 2006\u20132025) relevant to CKD-MBD management. Hyperphosphatemia drives VC through impaired renal excretion, upregulated intestinal phosphate absorption, and FGF-23 resistance. A critical gap identified is that conventional binders do not adequately address intracellular phosphate overload in vascular smooth muscle cells, where activation of osteogenic pathways occurs despite normalized serum levels. The \u201cphosphate storm\u201d concept \u2013 characterized by post-dialysis rebounds, postprandial peaks, and enhanced calciprotein particle formation \u2013 is introduced to better capture the deleterious kinetics of phosphate imbalance. Emerging evidence suggests that multitargeted strategies combining tenapanor with conventional binders, vitamin K2, and magnesium may reduce intestinal absorption and counteract cellular uptake, but the molecular basis of these diverse responses remains unresolved and long-term cardiovascular outcome data are lacking. Key Messages: Phosphate-lowering therapy may be considered when serum phosphate exceeds 3.9 mg\/dL or FGF-23 is elevated, though this threshold requires clinical validation. Tenapanor-based multitargeted regimens show promise in overcoming limitations of conventional treatments. Multimodal monitoring incorporating FGF-23, dp-ucMGP, and VC assessment, alongside a triad balance approach for serum phosphate, magnesium, and calcium, represents an exploratory framework requiring prospective validation.<\/jats:p>","DOI":"10.1159\/nef\/adtag004","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:54:37Z","timestamp":1789041277000},"page":"1-1","source":"Crossref","is-referenced-by-count":0,"title":["Phosphate Storm in Chronic Kidney Disease-Mineral and Bone Disorder: Practical Clinical Strategies for Vascular Calcification 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