Effect of variations in dietary Pi intake on intestinal Pi transporters (NaPi-IIb, PiT-1, and PiT-2) and phosphate-regulating factors (PTH, FGF-23, and MEPE)

Hyperphosphatemia is a common condition in patients with chronic kidney disease (CKD) and can lead to bone disease, vascular calcification, and increased risks of cardiovascular disease and mortality. Inorganic phosphate (P i ) is absorbed in the intestine, an important step in the maintenance of homeostasis. In CKD, it is not clear to what extent P i absorption is modulated by dietary P i . Thus, we investigated 5/6 nephrectomized (Nx) Wistar rats to test whether acute variations in dietary P i concentration over 2 days would alter hormones involved in P i metabolism, expression of sodium-phosphate cotransporters, apoptosis, and the expression of matrix extracellular phosphoglycoprotein (MEPE) in different segments of the small intestine. The animals were divided into groups receiving different levels of dietary phosphate: low (Nx/LP i ), normal (Nx/NP i ), and high (Nx/HP i ). Serum phosphate, fractional excretion of phosphate, intact serum fibroblast growth factor 23 (FGF-23), and parathyroid hormone (PTH) were significantly higher and ionized calcium was significantly lower in the Nx/HP i group than in the Nx/LP i group. The expression levels of NaPi-IIb and PiT-1/2 were increased in the total jejunum mucosa of the Nx/LP i group compared with the Nx/HP i group. Modification of P i concentration in the diet affected the apoptosis of enterocytes, particularly with P i overload. MEPE expression was higher in the Nx/HP i group than in the Nx/NP i . These data reveal the importance of early control of P i in uremia to prevent an increase in serum PTH and FGF-23. Uremia may be a determining factor that explains the expressional modulation of the cotransporters in the small intestine segments.