Phosphate homeostasis, monitoring and managment of hyperphosphatemia in patients with the Chronic Kidney diseases: Treatment / Management

Phosphate homeostasis, monitoring and managment of hyperphosphatemia in patients with the Chronic Kidney diseases

This section presents material on the significance of hyperphosphatemia in patients with CKD, Dietary Therapy for Managing Hyperphosphatemia

7. Treatment / Management

Improving Global Outcomes (KDIGO) guidelines for the management of hyperphosphatemia suggest that, in dialysis patients, phosphate levels require lowering toward the normal range; however, there is no given specific target level. In chronic kidney disease patients not receiving dialysis, serum phosphate levels require maintenance in the normal range (i.e., under 4.5 mg/dL [1.45 mmol/L]) (Ikizler TA).

Dietary interventions, including routine dietary assessment, dietary phosphate restriction, education on reading food labels, and meal preparation with demineralization methods, are core components of hyperphosphatemia management (Figure)

The cornerstones of hyperphosphatemia management in hemodialysis patients include dietary interventions, dialytic removal, and pharmacotherapies. Core components of tailored dietary therapy in hemodialysis patients include routine nutritional assessment and dietary counseling administered by dietitians. BMI, body mass index; Ca, Calcium; GI, gastrointestinal; IBW, ideal body weight; ISRNM, International Society of Renal Nutrition and Metabolism; K, potassium; MIS, malnutrition-inflammation score; Na, sodium; P, phosphate; PTH, parathyroid hormone; PEW, protein energy wasting; PROs, patient-reported outcomes; QOL, quality of life; SGA, subjective global assessment (Narasaki Y).

Acute hyperphosphatemia

If renal function is good, renal phosphate excretion can increase through extracellular volume expansion by saline infusion and diuretics.

Bibliography

Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, Fouque D, Friedman AN, Ghaddar S, Goldstein-Fuchs DJ, Kaysen GA, Kopple JD, Teta D, Yee-Moon Wang A, Cuppari L: KDOQI clinical practice guideline for nutrition in CKD: 2020 update [published correction appears in Am J Kidney Dis S0272-6386(20): 31125–2, 2020 10.1053/j.ajkd.2020.11.004]. Am J Kidney Dis 76[Suppl 1]: S1–S107, 2020

Narasaki Y, Rhee CM. Dietary Therapy for Managing Hyperphosphatemia. Clin J Am Soc Nephrol. 2020 Dec 31;16(1):9-11. doi: 10.2215/CJN.18171120. PMID: 33380472; PMCID: PMC7792640.