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Nephrol Dial Transplant. 2013 Dec;28(12):2961-8. doi: 10.1093/ndt/gft244. Epub 2013 Jul 30.

Phosphate control in end-stage renal disease: barriers and opportunities.

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1
The Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida, USA.

Abstract

Hyperphosphatemia is a nearly universal complication of end-stage renal disease that is widely recognized as one of the most important and most challenging clinical targets to meet in the care of dialysis patients. Left untreated, it can lead to bone pain, pruritus and worsening secondary hyperparathyroidism. Data from observational studies demonstrate that an elevated serum phosphorus level is an independent risk factor for mortality, and that treatment with phosphate binders is independently associated with improved survival. Experimental studies provide support for the epidemiologic findings: phosphate excess promotes vascular calcification, induces endothelial dysfunction and may contribute to other emerging chronic kidney disease-specific mechanisms of cardiovascular toxicity. On the basis of this evidence, clinical practice guidelines recommend specific targets for serum phosphorus levels in the dialysis population. The purpose of this review is to summarize common challenges in meeting these targets and to identify potential opportunities for improvement.

KEYWORDS:

dialysis; phosphate binders; phosphorus

PMID:
23901051
PMCID:
PMC3843343
DOI:
10.1093/ndt/gft244
[Indexed for MEDLINE]
Free PMC Article
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