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New approaches to the treatment of calcium and phosphorus abnormalities in patients on hemodialysis

Disturbances in calcium and phosphorus are common in patients who are on chronic hemodialysis. Current therapy consists mainly of administration of calcium-containing phosphate binders and calcitriol. However, the use of these therapies has been limited by both iatrogenic hypercalcemia and hyperphosphatemia. Indeed, hyperphosphatemia and elevations in the calcium×phosphorus product have recently been linked to increased mortality and a high burden of cardiac calcifications on electron-beam computed tomography. Novel therapeutic agents such as sevelamer and vitamin D analogs have thus been developed with the goal of decreasing oral calcium loading and hypercalcemia. We provide an algorithm for the management of calcium and phosphorus abnormalities, based on newer recommendations for tighter calcium and phosphorus control with a lower target for the calcium×phosphorus product.