From the Guidelines
Yes, I would treat hyperphosphatemia, as it is associated with increased morbidity, mortality, and decreased quality of life, particularly in patients with chronic kidney disease (CKD) 1.
Treatment Approach
The treatment approach for hyperphosphatemia should be individualized, taking into account the patient's underlying condition, kidney function, and other biochemical variables such as serum calcium and parathyroid hormone (PTH) levels 1.
- The goal of treatment is to lower serum phosphorus levels to normal or near-normal range, while minimizing the risk of hypercalcemia and other adverse effects.
- Dietary phosphate restriction is an important component of treatment, but it may not be sufficient to control hyperphosphatemia in all patients, particularly those with advanced CKD 1.
- Phosphate binders, such as sevelamer or lanthanum carbonate, may be necessary to control hyperphosphatemia, especially in patients with CKD stages 3 to 5 1.
Key Considerations
- The choice of phosphate binder should be based on the patient's individual needs and medical history, as well as the potential risks and benefits of each agent 1.
- Calcium-based phosphate binders should be used with caution, as they may increase the risk of hypercalcemia and arterial calcification, particularly in patients with CKD 1.
- Regular monitoring of serum phosphorus, calcium, and PTH levels is essential to adjust treatment and prevent adverse effects 1.
Recent Evidence
- A recent study published in 2018 found that sevelamer, a calcium-free phosphate binder, was effective in lowering serum phosphorus levels and reducing the risk of hypercalcemia and arterial calcification in patients with CKD 1.
- Another study published in 2018 found that limiting dietary phosphate intake was an effective strategy for managing hyperphosphatemia in patients with CKD, particularly in those with CKD stages 3 to 5 1.
From the FDA Drug Label
As a phosphorus supplement, each tablet supplies 20% of the U.S. Recommended Daily Allowance (U.S. RDA) of phosphorus for adults andchildren over 4 years of age. Phosphorous Tablets increases urinary phosphate and pyrophosphate. Contraindications This product is contradicted in patients with infected phosphate stones in the urinary tract, in patients with severely impaired renal function (less than 30% of normal) and in the presence of hyperphosphatemia.
- The drug is a phosphorus supplement, which increases phosphorus levels.
- It is contraindicated in patients with hyperphosphatemia.
- Therefore, this drug does not treat hyperphosphatemia, but rather may exacerbate it. 2
From the Research
Treatment of Hyperphosphatemia
- Hyperphosphatemia can be treated with fluid administration, and in cases of chronic hyperphosphatemia, phosphate binders such as aluminum and magnesium salts can be used to reduce the phosphate load 3.
- The use of phosphate binders is limited by their potential side effects, and constant monitoring is necessary to prevent complications 4.
- Hyperphosphatemia can occur in renal failure, hemolysis, tumor lysis syndrome, and rhabdomyolysis, and treatment should be tailored to the underlying cause 3.
Causes of Hyperphosphatemia
- The most frequent cause of hyperphosphatemia is chronic renal disease 5.
- Other causes of hyperphosphatemia include increased tubular reabsorption, increased intestinal absorption, and redistribution to the extracellular pool 5.
Comparison with Hypophosphatemia Treatment
- In contrast to hyperphosphatemia, hypophosphatemia can be treated with enteral or parenteral phosphate salts, and prevention of depletion is an important aspect of management 3.
- Hypophosphatemia can be caused by nutritional repletion, gastrointestinal malabsorption, use of phosphate binders, starvation, diabetes mellitus, and increased urinary losses due to tubular dysfunction 3.