Hyperphosphatemia and the associated conditions begin to appear as GFR declines <60 ml/min. Hyperphosphatemia, elevated parathyroid hormone (PTH), secondary hyperparathyroidism with depressed serum calcium and vitamin D deficiency are metabolic disturbances that require early detection and treatment to prevent bone disease of chronic hyperparathryoidism, and to minimize the increased risk for cardiovascular disease. Evaluating, preventing and monitoring hyperparathyroidism requires data on serum calcium, serum phosphate and intact-PTH. Treatment needs to be individualized and may include dietary phosphate restriction and/or phosphate binders and calcium and vitamin D supplementation and self-management training. Dietary phosphorus intakes are correlated with dietary protein intakes; therefore diets restricted in protein are also lower in phosphorus.
