From the Guidelines
Treatment for hyperphosphatemia should focus on patients with overt hyperphosphatemia, and should begin with dietary phosphate restriction to 800-1000 mg daily, focusing on limiting high-phosphate foods like processed foods, dairy, and certain meats. Phosphate binders are the mainstay of treatment and should be taken with meals. Options include calcium-based binders such as calcium carbonate (500-1500 mg three times daily) or calcium acetate (667 mg, 2-3 tablets per meal), or non-calcium binders like sevelamer (800-1600 mg three times daily) or lanthanum carbonate (500-1000 mg with meals) 1. For patients with chronic kidney disease, addressing the underlying renal dysfunction is crucial, which may include optimizing dialysis if applicable 1. In acute cases, increasing dialysis frequency or intensity can rapidly lower phosphate levels. Treatment efficacy should be monitored with regular phosphate level checks every 1-2 weeks initially, then monthly once stabilized. Hyperphosphatemia requires treatment because elevated phosphate levels can lead to secondary hyperparathyroidism, renal osteodystrophy, and increased cardiovascular risk through vascular calcification 1. Key considerations in treatment include avoiding hypercalcemia and individualizing phosphate-lowering treatment decisions, as excess exposure to calcium may be harmful across all GFR categories of CKD 1.
Some key points to consider in the treatment of hyperphosphatemia include:
- Dietary phosphate restriction is a crucial first step in managing hyperphosphatemia
- Phosphate binders should be used judiciously, with consideration of the potential risks and benefits of different types of binders
- Addressing underlying renal dysfunction is essential in patients with chronic kidney disease
- Regular monitoring of phosphate levels is necessary to adjust treatment as needed
- Avoiding hypercalcemia and individualizing treatment decisions are critical in minimizing the risks associated with hyperphosphatemia treatment.
Overall, the goal of treatment for hyperphosphatemia is to reduce phosphate levels, minimize the risks of cardiovascular and renal complications, and improve patient outcomes. By prioritizing dietary phosphate restriction, judicious use of phosphate binders, and addressing underlying renal dysfunction, clinicians can help patients with hyperphosphatemia achieve better health outcomes 1.
From the FDA Drug Label
The phosphate binding effect of calcium acetate is shown in the Table 3. Table 3: Serum Phosphorous and Calcium Levels at Study Initiation and After Completion of Each Treatment Arm Parameter Pre-Study Post-Treatment p-valueb Calcium Acetate Placebo Phosphorus (mg/dL)a 7.3 ± 0.18 5.9 ± 0.24 7.8 ± 0.22 <0.01 Calcium (mg/dL)a 8.9 ± 0.11 9.5 ± 0.13 8.8 ± 0.12 <0. 01 Overall, 2 weeks of treatment with calcium acetate statistically significantly (p<0.01) decreased serum phosphorus by a mean of 19% and increased serum calcium by a statistically significant (p<0.01) but clinically unimportant mean of 7% 2.
The ability of sevelamer hydrochloride to lower serum phosphorus in CKD patients on dialysis was demonstrated in six clinical trials: one double-blind placebo-controlled 2-week study (sevelamer hydrochloride N=24); two open-label uncontrolled 8-week studies (sevelamer hydrochloride N=220) and three active-controlled open-label studies with treatment durations of 8 to 52 weeks (sevelamer hydrochloride N=256) 3.
The treatment for hyperphosphatemia (elevated phosphate levels) includes:
- Calcium acetate: decreases serum phosphorus by a mean of 19% and increases serum calcium by a mean of 7% 2
- Sevelamer hydrochloride: lowers serum phosphorus in CKD patients on dialysis, with a mean reduction of 2 mg/dL in serum phosphorus levels 3 Key points:
- Both calcium acetate and sevelamer hydrochloride are effective in reducing serum phosphorus levels
- The choice of treatment may depend on individual patient needs and clinical circumstances
From the Research
Treatment Options for Hyperphosphatemia
The treatment for hyperphosphatemia, a condition characterized by elevated phosphate levels in the blood, typically involves a combination of dietary restrictions and phosphate binders 4, 5, 6.
- Dietary Restrictions: A low-phosphate diet is often recommended to minimize phosphate intake, while ensuring adequate protein consumption 4, 6.
- Phosphate Binders: Various types of phosphate binders are available, including:
- Calcium-based salts (e.g., calcium acetate, calcium carbonate) 4, 5, 6, 7
- Non-calcium-based binders (e.g., sevelamer, lanthanum carbonate, magnesium salts) 4, 5, 6, 7
- Aluminum-containing agents (although their use is limited due to toxicity concerns) 4, 5, 7
- Iron-based preparations 5
- Resin-based binders (e.g., colestilan) 7
Phosphate Binder Selection
The choice of phosphate binder should be individualized, considering factors such as clinical context, cost, and patient tolerability 4, 5, 7.
- Calcium-Based Binders: Effective, but may lead to hypercalcemia, positive calcium balance, and cardiovascular calcification 4, 5, 7.
- Non-Calcium-Based Binders: May be preferred in certain situations, but their long-term effects and comparative efficacy are not fully established 4, 5, 7.
Additional Strategies
Other approaches to managing hyperphosphatemia include: