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Hyperphosphatemia and phosphate binders.

Jason J Schucker1, Kristina E Ward

  • 1Hannaford Pharmacy, Waterboro, ME, USA.

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|November 10, 2005
PubMed
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Hyperphosphatemia in end-stage renal disease (ESRD) leads to serious complications. Phosphate binders effectively manage serum phosphate levels, with selection based on individual patient factors and tolerability.

Area of Science:

  • Nephrology
  • Biochemistry
  • Pharmacology

Background:

  • Phosphorus is vital for cellular functions, with kidneys regulating serum levels.
  • Renal insufficiency impairs phosphorus excretion, leading to hyperphosphatemia.
  • Uncontrolled hyperphosphatemia causes secondary hyperparathyroidism and renal osteodystrophy.

Purpose of the Study:

  • To discuss the pathophysiology of hyperphosphatemia in end-stage renal disease (ESRD).
  • To review the role and types of phosphate binders in managing hyperphosphatemia.

Main Methods:

  • Literature review of pathophysiology and treatment of hyperphosphatemia in ESRD.
  • Analysis of available phosphate binders, including calcium carbonate, calcium acetate, sevelamer, and lanthanum.

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Main Results:

  • Phosphate binders are crucial for managing serum phosphate in ESRD patients.
  • Different binders (calcium carbonate, calcium acetate, sevelamer, lanthanum) vary in efficacy and tolerability.
  • Aluminum-based binders are limited due to toxicity; calcium carbonate has narrow pH utility.

Conclusions:

  • Effective management of hyperphosphatemia in ESRD involves dialysis, diet, phosphate binders, and vitamin D analogs.
  • Binder selection should consider patient-specific factors like serum levels and tolerability.
  • Untreated hyperphosphatemia can lead to severe complications, including vascular calcification.