From the Guidelines
Hyperphosphatemia should be managed through dietary restrictions and phosphate binders, focusing on patients with overt hyperphosphatemia, as current evidence does not show benefit to maintaining normal serum phosphate levels in patients not receiving dialysis. The treatment approach should be based on serial assessments of biochemical variables, including serum phosphate, calcium, and PTH, taken together 1.
Key Considerations
- Dietary restrictions should limit phosphorous-rich foods like dairy products, processed foods, and dark sodas.
- Phosphate binders such as calcium acetate, sevelamer, or lanthanum carbonate can be used to prevent phosphorous absorption, and should be taken with food to effectively bind dietary phosphate.
- For patients with kidney disease, adhering to the dialysis schedule is crucial in removing excess phosphorous.
- Regular blood tests are essential to monitor levels and adjust treatment accordingly.
Treatment Approach
- The use of calcium-based phosphate binders should be restricted in patients with hyperphosphatemia across the CKD spectrum 1.
- Treatment approaches for secondary hyperparathyroidism (SHPT) in patients not receiving dialysis should not include routine use of calcitriol or vitamin D analogues due to the increased risk for hypercalcemia 1.
- Calcimimetics, calcitriol, and vitamin D analogues are acceptable first-line options in patients receiving dialysis 1.
Rationale
- Hyperphosphatemia can lead to calcium deposits in blood vessels and tissues, increasing cardiovascular risk and causing bone disorders.
- It is often associated with kidney dysfunction, which impairs the body's ability to excrete excess phosphorous.
- The plasma level of PTH is a better marker in the early course of CKD for the need to begin dietary phosphate restriction than is serum phosphorus, calcium, or creatinine levels 1.
From the FDA Drug Label
Patients with ESRD retain phosphorus and can develop hyperphosphatemia. High serum phosphorus can precipitate serum calcium resulting in ectopic calcification. Hyperphosphatemia also plays a role in the development of secondary hyperparathyroidism in patients with ESRD. The implications of hyperphosphatemia (elevated phosphorus levels) include:
- Ectopic calcification: High serum phosphorus can precipitate serum calcium, resulting in ectopic calcification.
- Secondary hyperparathyroidism: Hyperphosphatemia plays a role in the development of secondary hyperparathyroidism in patients with End-Stage Renal Disease (ESRD) 2.
From the Research
Implications of Hyperphosphatemia
The implications of hyperphosphatemia, or elevated phosphorus levels, are numerous and can have severe consequences on the body. Some of the key implications include:
- Hyperparathyroidism and renal osteodystrophy, as noted in patients with chronic kidney disease (CKD) 3
- Vascular calcification and increased mortality, which can be exacerbated by hyperphosphatemia 3, 4
- Cardiovascular disease and sudden death, often observed in patients with end-stage renal disease 4
- Organ calcification, which can lead to further complications and morbidity 4
Associated Conditions
Hyperphosphatemia is often associated with other conditions, including:
- Chronic kidney disease (CKD), where hyperphosphatemia is a common disorder 3, 5
- End-stage renal disease, where hyperphosphatemia and hyperparathyroidism are frequently observed 4
- Cardiovascular disease, which can be exacerbated by hyperphosphatemia 4, 6
Treatment and Management
Treatment and management of hyperphosphatemia typically involve:
- Dietary restriction of phosphorus, which can be challenging due to the presence of phosphorus in many foods and additives 3, 6
- Phosphate binders, which can help reduce intestinal phosphate absorption 5, 6
- Adjustments to dialysis prescription, which can help manage hyperphosphatemia in patients with late-stage CKD 6
- Individualized approach, involving a combination of dietary advice, phosphate-binder use, and adjustments to dialysis prescription 6