Management of Hyperphosphatemia in End-Stage Renal Disease: A New Paradigm

Bone and mineral metabolism becomes dysregulated with progression of chronic kidney disease (CKD), and increasing levels of parathyroid hormone serve as an adaptive response to maintain normal phosphorus and calcium levels. In end-stage renal disease, this response becomes maladaptive and high levels of phosphorus may occur. We summarize strategies to control hyperphosphatemia based on a systematic literature review of clinical trial and real-world observational data on phosphorus control in hemodialysis patients with CKD-mineral bone disorder (CKD-MBD). These studies suggest that current management options (diet and lifestyle changes; regular dialysis treatment; and use of phosphate binders, vitamin D, calcimimetics) have their own benefits and limitations with variable clinical outcomes. A more integrated approach to phosphorus control in dialysis patients may be necessary, incorporating measurement of multiple biomarkers of CKD-MBD pathophysiology (calcium, phosphorus, and parathyroid hormone) and correlation between diet adjustments and CKD-MBD drugs, which may facilitate improved patient management. (C) 2020 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.

Automated summary

In CKD, bone and mineral metabolism becomes dysregulated, leading to high levels of parathyroid hormone and potential issues with phosphorus control. Strategies for controlling hyperphosphatemia in dialysis patients have benefits and limitations, suggesting the need for a more integrated approach incorporating multiple biomarkers and correlation between diet adjustments and medications for improved patient management.