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[Treatment of hyperphosphatemia in hemodialysis patients]

Philippe Rieu1

  • 1Service de néphrologie, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims, France. prieu@chu-reims.fr

Nephrologie & Therapeutique
|March 22, 2007
PubMed

Insights

Managing hyperphosphatemia is crucial for hemodialysis patients to prevent complications like hyperparathyroidism and reduce mortality. This review covers dietary, dialytic, and pharmacologic strategies, including phosphate binders and nicotinamide.

Area of Science:

  • Nephrology
  • Endocrinology
  • Internal Medicine

Context:

  • Hyperphosphatemia is a significant complication in hemodialysis patients, linked to secondary hyperparathyroidism, extraosseous calcification, and increased mortality.
  • Current guidelines, such as NFK-KDOQI 2003, advocate for strict serum phosphorus control within the range of 1.13–1.78 mmol/l.

Purpose:

  • This review critically examines multifaceted strategies for managing hyperphosphatemia in patients undergoing dialysis.
  • It aims to provide an updated overview of therapeutic approaches, including dietary modifications, enhanced dialysis, phosphate binders, nicotinamide, and parathyroid hormone level management.

Summary:

  • Effective hyperphosphatemia management involves a comprehensive approach: reducing dietary phosphorus, optimizing phosphate removal during dialysis, utilizing phosphate binders (both traditional and novel calcium-free options), considering nicotinamide therapy, and controlling parathyroid hormone levels.
  • The review also re-evaluates recent recommendations regarding the restriction of supplemental elemental calcium intake to 1.5 g daily.

Impact:

  • Optimizing hyperphosphatemia treatment can significantly improve patient outcomes by mitigating secondary hyperparathyroidism and reducing calcification risks.
  • This review supports clinicians in refining patient management strategies, potentially leading to decreased mortality rates in the hemodialysis population.

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