endocrine and metabolic disorders
Hyperphosphatemia
Treatment of Hyperphosphatemia
Phosphate restriction Phosphate binders Sometimes saline diuresis or hemodialysis The mainstay of treatment in patients with advanced chronic kidney disease is reduction of phosphate intake, which is usually accomplished with avoidance of foods containing high amounts of phosphate and with use of phosphate-binding medications taken with meals. Although quite effective, aluminum-containing antacids should not be used as phosphate binding agents in patients with end-stage renal disease because of the possibility of aluminum-related dementia and osteomalacia. Calcium carbonateandcalcium acetateare frequently used as phosphate binders. But their use requires close monitoring because of the possibility of excessive calcium×phosphate product causing vascular calcification in patient on dialysis who are taking calcium-containing binders. A phosphate-binding resin without calcium,sevelamer, is widely used in patients on dialysis. It is given in doses of 800 to 2400 mg orally 3 times a day with meals.Lanthanum carbonateis another phosphate binder that lacks calcium and is used in patients on dialysis. It is given in doses of 500 to 1000 mg orally 3 times a day with meals. Sucroferric oxyhydroxide combines elemental iron with phosphate binding because many patients on dialysis need both. It is given in doses of 500 mg orally 3 times a day with meals. Hemodialysis does remove some phosphate, but not enough to allow most patients with end-stage renal disease to avoid significant hyperphosphatemia without dietary interventions. Saline diuresis can be used to enhance phosphate elimination in cases of acute hyperphosphatemia in patients with intact kidney function. Hemodialysis can lower phosphate levels in cases of severe acute hyperphosphatemia. 