Hyperphosphatemia among patients with chronic kidney disease

Background: Hyperphosphatemia alone or in combination with hypercalcemia has been associated with increased mortality and morbidity among patients with chronic kidney disease (CKD). The present study aimed to review some of published articles about treatment of hyperphosphatemia among patients with CKD. Materials and Methods: To collect the current data, many articles were reviewed in a variety of sources such as PubMed, Scopus, Current Content, Embase, and IranMedex with keywords of "hyperphosphatemia" and "chronic kidney disease". Only articles published in English language, as full-text manuscripts, were included in this article. Results: Common treatment of hyperphosphatemia among patients with CKD is dietary phosphate restriction and administration of phosphate binders to block absorption of ingested phosphate from the intestine. Phosphate restriction should primarily include unnecessary dietary phosphate (as many processed foods, colas, dairy products and certain vegetables). Phosphate-binding agents are categorized as calcium-containing phosphate binders (calcium carbonate and calcium acetate) and noncalcium-containing phosphate binders (sevelamer and lanthanum). All of phosphate-binding agents are effective in lowering serum phosphate; however, noncalcium-containing phosphate binders are preferred among hypercalcemic patients, normocalcemic patients who also received vitamin D analogs, patients with vascular calcification and patients with adynamic bone disease. Conclusion: There is a concern about safety of calcium-containing binders for long-term use and these agents may be associated with hypercalcemia, vascular calcification and adynamic bone disease.