TNF and hyperphosphatemia: Additionally, hyperphosphatemia in patients on maintenance hemodialysis elevated a “systemic inflammatory response” by increasing expression of the Pi transporter 1 (PiT-1) in monocytes [56] This in turn stimulated synthesis and secretion of the proinflammatory cytokines tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6).