【摘要】 我国透析患者血磷达标率低，急需分层和个体化管理。早期慢性肾脏病（CKD）患者因肾小球滤过率下降导致磷潴留和成纤维细胞生长因子23/甲状旁腺激素/Klotho轴紊乱，并促进多器官钙化。传统措施（限磷饮食、强化透析、磷结合剂）的疗效与耐受性有限。替那帕诺等新药和人工智能（AI）技术的发展提高了高磷血症控制率与安全性，临床管理目标从“生化达标”转向“改善结局”。2023年改善全球肾脏病预后组织（KDIGO）会议提出的血磷管理新模式：聚焦“CKD-骨质疏松”及“CKD-心血管病”综合征；未来的策略包括强化透析、联合用药和基于AI的个体化决策。更多还原

【Abstract】 In China, only a minority of dialysis patients achieve recommended serum phosphate targets, underscoring the urgent need for stratified and individualized management. In early chronic kidney disease(CKD), declining glomerular filtration rate precipitates phosphate retention and dysregulation of the FGF-23/PTH/Klotho axis, driving multi-organ calcification. Conventional interventions exhibit limited efficacy and tolerability such as dietary phosphate restriction, intensified dialysis, and phosphate binders. The advent of tenapanor and other novel agents, together with artificial intelligence(AI) has markedly improved phosphate control and safety, shifting the therapeutic goal from “biochemical normalization” to “patient-centered outcomes. ” The 2023 KDIGO Controversies Conference advanced a new paradigm that integrates “CKD-osteoporosis” and “CKDcardiovascular disease” syndromes. Future strategies will emphasize intensified dialysis, combination pharmacotherapy, and AIguided individualized decision-making.更多还原