PTH and hyperphosphatemia: However, the use of urinary phosphate excretion alone may be not a strong predictor of phosphate balance in patients affected by CKD [171]: in patients with normal renal function, a dietary phosphate load does not lead to hyperphosphatemia because of a compensatory increase in urinary phosphate excretion induced by phosphaturic hormones such as PTH and FGF-23 [167,172].