CKD: Hyperphosphatemia (2001)
Hyperphosphatemia and CKD (2001)
What does the research indicate about hyperphosophatemia in chronic kidney disease? (2001 CD)
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.
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
Evidence Summary: Hyperphosphatemia in Chronic Kidney Disease (2001)
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Block GA, Port FK. Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Diseases 2000; 35:1226-1237.
- Cannata-Andia J, Passlick-Deetjen J, Ritz E (eds). Management of the renal patient: experts' recommendations and clinical algorithms on renal osteodystrophy and cardiovascular risk factors. Nephrol Dial Transplant 2000; 15 (suppl 5):39-57.
- Combe C, Morel D, de Precigout V, Blanchetier V, Bouchet JL, Potaux L, Fournier A, Aparicio M. Long-term control of hyperparathyroidism in advanced renal failure by low-phosphorus low-protein diet supplemented with calcium (without changes in plasma calcitriol). Nephron 1995; 70(30):287-295.
- Delmez JA, Slatopolsky E. Hyperphosphatemia: Its consequences and treatment in patients with chronic renal disease. Am J Kidney Diseases 1992; 19:303-317.
- Fajtova VT, Sayegh MH, Hickey N, Aliabadi P, Lazarus JM, LeBoff MS. Intact parathyroid hormone levels in renal insufficiency. Calcif Tissue Int. 1995; 57:329-335.
- Kates DM, Sherrard DJ, Andress DL. Evidence that serum phosphate is independently associated with serum PTH in patients with chronic renal failure. Am J Kidney Diseases 1997;30:809-813.
- Martin KJ, Gonzales EA. Vitamin D analogues for the management of secondary hyperparathyroidism. Am J Kidney Diseases 2001;38 (suppl 5):S34-S40.
- Martinez I, Saracho R, Montenegro J, Llach F. The importance of dietary calcium and phosphorous in the secondary hyperparathyroidism of patients with early renal failure. Am J Kidney Dis 1997;29(4):496-502.
- Schomig M, Ritz E. Management of disturbed calcium metabolism in uraemic patients: use of vitamin D metabolites. Nephrol Dial Transplant 2000;15(Suppl 5):18 - 24.
- Torres A, Lorenzo V, Hernandez D, Rodriguez JC, Concepcion MT, Rodriguez AP, Hernandez A, de Bonis E, Darias E, Gonzalez-Posada JM, Losada M, Rufino M, Felsenfeld AJ, Rodriguez M. Bone disease in predialysis, hemodialysis and CAPD patients: evidence of a better bone response to PTH. Kidney Int 1995;47:1434-1442.