Clin Osteol 2003; 8(2): 47-51

Current approach to hyperphosphataemia in patients with end stage renal diseaseArticles

S. Sulková, F. Svára, M. Fortová, M. Válek

Patients with end stage renal disease (ESRD) frequently suffer from an imbalance of phosphorus and calcium and are frequently diagnosed with hy­ perphosphataemia, caused by inadequate excretion of blood phosphorus by the kidney. Progressive decrease in glomerular filtration rate (GFR) leads to a progressive increase in blood phosphorus level. Hyperphosphataemia and current interventions are suggested to be the basis for multiple comor­ bidities in ESRD patients on chronic haemodialysis. Increased blood phosphorus levels lead to an increase in calcium-phosphorus ion product and con­ sequent soft tissue calcifications.The current treatment of hyperphosphataemia is based on control of diet and the binding of ingested phosphates from food, especially from dietary proteins. Until recently, aluminum hydroxide and calcium salts have been used to bind ingested phosphates and thereby minimise phosphate absorption. Unfortunately, these treatments have serious side effects. Aluminum hydroxide causes bone, brain, muscle and bone marrow toxicity, resulting in osteomalacia, encephalopathy, neuropathy and microcytic anaemia, and is currently only indicated as a short-term inter­ vention. Calcium acetate and calcium carbonate are the most commonly used calcium salts in the treatment of hyperphosphataemia. Calcium carbo­ nate is most commonly used in Europe andJapan; whereas, calcium acetate is most commonly used in the United States. However, calcium salts might contribute to the increase in calcium-phosphorus ion product. Recently, sevelamer, a resin based phosphate binder, has been marketed in the US and Europe. Other two phosphate binders, lanthanum and colestimide, have been used in clinical trials only. The most promising, and a very different drug seems to be the calcimimetic AMG 073 due to its ability to decrease the parathyroid hormone secretion and calcium-phosphorus ion product.

Keywords: end stage renal disease, phosporus, hyperphosphataemia.

Published: December 11, 2003  Show citation

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Sulková S, Svára F, Fortová M, Válek M. Current approach to hyperphosphataemia in patients with end stage renal disease. Osteologický bulletin. 2003;8(2):47-51.
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