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Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management.
Am J Kidney Dis. 2000 Jun; 35(6):1226-37.AJ

Abstract

Hyperphosphatemia is a predictable consequence of chronic renal failure and is present in most patients on dialysis. Traditionally, the risk associated with elevated serum phosphorus has focused on its impact on renal osteodystrophy. A growing body of evidence, however, suggests that abnormalities in serum phosphorus, calcium-phosphorus product (CaxP), and parathyroid hormone (PTH) levels are resulting in vascular and visceral calcification, thereby contributing to the substantially increased risk of cardiovascular death in this population. In this analysis, we review in detail the literature that describes these associations. We show that the current treatment paradigm for serum phosphorus and secondary hyperparathyroidism is ineffective for a large segment of dialysis patients. Currently, 60% of hemodialysis patients have phosphorus greater than 5.5 mg/dL, and 40% have CaxP greater than 60 mg(2)/dL(2). It is our belief that prevention of uremic calcification, cardiac death, and vascular disease should assume primary importance when evaluating the risks associated with elevated levels of phosphorus, CaxP, and PTH. We recommend that target levels should become 9.2 to 9.6 mg/dL for calcium, 2.5 to 5.5 mg/dL for phosphorus, less than 55 mg(2)/dL(2) for CaxP product, and 100 to 200 pg/mL for intact PTH.

Authors+Show Affiliations

Denver Nephrologists, PC, Denver, CO, USA. gblock@denverneph.netNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

10845841

Citation

Block, G A., and F K. Port. "Re-evaluation of Risks Associated With Hyperphosphatemia and Hyperparathyroidism in Dialysis Patients: Recommendations for a Change in Management." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 35, no. 6, 2000, pp. 1226-37.
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 Dis. 2000;35(6):1226-37.
Block, G. A., & Port, F. K. (2000). Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 35(6), 1226-37.
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 Dis. 2000;35(6):1226-37. PubMed PMID: 10845841.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. AU - Block,G A, AU - Port,F K, PY - 2000/6/10/pubmed PY - 2000/7/6/medline PY - 2000/6/10/entrez SP - 1226 EP - 37 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 35 IS - 6 N2 - Hyperphosphatemia is a predictable consequence of chronic renal failure and is present in most patients on dialysis. Traditionally, the risk associated with elevated serum phosphorus has focused on its impact on renal osteodystrophy. A growing body of evidence, however, suggests that abnormalities in serum phosphorus, calcium-phosphorus product (CaxP), and parathyroid hormone (PTH) levels are resulting in vascular and visceral calcification, thereby contributing to the substantially increased risk of cardiovascular death in this population. In this analysis, we review in detail the literature that describes these associations. We show that the current treatment paradigm for serum phosphorus and secondary hyperparathyroidism is ineffective for a large segment of dialysis patients. Currently, 60% of hemodialysis patients have phosphorus greater than 5.5 mg/dL, and 40% have CaxP greater than 60 mg(2)/dL(2). It is our belief that prevention of uremic calcification, cardiac death, and vascular disease should assume primary importance when evaluating the risks associated with elevated levels of phosphorus, CaxP, and PTH. We recommend that target levels should become 9.2 to 9.6 mg/dL for calcium, 2.5 to 5.5 mg/dL for phosphorus, less than 55 mg(2)/dL(2) for CaxP product, and 100 to 200 pg/mL for intact PTH. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/10845841/Re_evaluation_of_risks_associated_with_hyperphosphatemia_and_hyperparathyroidism_in_dialysis_patients:_recommendations_for_a_change_in_management_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(00)70064-3 DB - PRIME DP - Unbound Medicine ER -