Higher Serum Phosphate—Another Undesirable Effect of Smoking?

We read with interest the article by Formanek et al1 focusing on strategies to help patients with chronic kidney disease (CKD) quit smoking. The authors described increased cardiovascular risk in patients with CKD who smoke, which is superimposed on the already existent risk. However, little is known about the mechanisms of harm from smoking in patients with CKD. Because CKD–mineral and bone disorder confers a huge increase in cardiovascular mortality and phosphate is a key player in this syndrome, this letter intends to contextualize the association between phosphate and smoking.

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