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Management of hyperphosphatemia in patients with renal failure.
Curr Opin Nephrol Hypertens. 1993 Jul; 2(4):566-79.CO

Abstract

Phosphate retention plays a major role in the pathogenesis of hyperparathyroidism at all stages of renal insufficiency. Dietary phosphate restriction is mandatory only for adults and is not advised for children because of the recommended diet allowance. Dietary restriction is usually not sufficient, and phosphate binders are almost always necessary when the glomerular filtration rate falls below 40 mL/min. Because long-term administration of aluminum phosphate binders is associated with risk of aluminum intoxication despite the use of so-called "safe doses", alternative phosphate binders should be used. Magnesium hydroxide and carbonate can be used only for dialysis patients because a low dialysate magnesium concentration is necessary to prevent the hazards of hypermagnesemia. Therefore, the major alternative is the use of alkaline salts of calcium. The most recently proposed salt, acetate, has a higher phosphate-binding capacity than carbonate but exposes patients to the same incidence of hypercalcemia despite the use of half the dose of elemental calcium. These salts should be taken with meals in order to complex more dietary phosphate and decrease calcium absorption and therefore the risk of hypercalcemia. Oral calcium alone, without 1 alpha OH-vitamin D3 derivatives, can prevent hyperphosphatemia and hyperparathyroidism in most uremic patients before dialysis and in about half of the patients dialyzed with a dialysate calcium of 1.5 to 1.65 mmol/L. 1 alpha OH-vitamin D3 derivatives, which increase intestinal absorption of phosphate, should be used only when hyperphosphatemia has been prevented by oral calcium and diet and when plasma parathyroid hormone levels increase above three times the upper limit of normal. To decrease hypercalcemic risk, patients should be given 1 alpha OH-vitamin D3 derivatives, preferably at night, as an intermittent bolus (intravenous or oral). In dialysis patients, the dialysate concentration of calcium may have to be further decreased in order to prevent hypercalcemia when high doses of oral calcium are necessary to control hyperphosphatemia.

Authors+Show Affiliations

Centre Hospitalier Universitaire D'Amiens, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

7859019

Citation

Ghazali, A, et al. "Management of Hyperphosphatemia in Patients With Renal Failure." Current Opinion in Nephrology and Hypertension, vol. 2, no. 4, 1993, pp. 566-79.
Ghazali A, Ben Hamida F, Bouzernidj M, et al. Management of hyperphosphatemia in patients with renal failure. Curr Opin Nephrol Hypertens. 1993;2(4):566-79.
Ghazali, A., Ben Hamida, F., Bouzernidj, M., el Esper, N., Westeel, P. F., & Fournier, A. (1993). Management of hyperphosphatemia in patients with renal failure. Current Opinion in Nephrology and Hypertension, 2(4), 566-79.
Ghazali A, et al. Management of Hyperphosphatemia in Patients With Renal Failure. Curr Opin Nephrol Hypertens. 1993;2(4):566-79. PubMed PMID: 7859019.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of hyperphosphatemia in patients with renal failure. AU - Ghazali,A, AU - Ben Hamida,F, AU - Bouzernidj,M, AU - el Esper,N, AU - Westeel,P F, AU - Fournier,A, PY - 1993/7/1/pubmed PY - 1993/7/1/medline PY - 1993/7/1/entrez SP - 566 EP - 79 JF - Current opinion in nephrology and hypertension JO - Curr. Opin. Nephrol. Hypertens. VL - 2 IS - 4 N2 - Phosphate retention plays a major role in the pathogenesis of hyperparathyroidism at all stages of renal insufficiency. Dietary phosphate restriction is mandatory only for adults and is not advised for children because of the recommended diet allowance. Dietary restriction is usually not sufficient, and phosphate binders are almost always necessary when the glomerular filtration rate falls below 40 mL/min. Because long-term administration of aluminum phosphate binders is associated with risk of aluminum intoxication despite the use of so-called "safe doses", alternative phosphate binders should be used. Magnesium hydroxide and carbonate can be used only for dialysis patients because a low dialysate magnesium concentration is necessary to prevent the hazards of hypermagnesemia. Therefore, the major alternative is the use of alkaline salts of calcium. The most recently proposed salt, acetate, has a higher phosphate-binding capacity than carbonate but exposes patients to the same incidence of hypercalcemia despite the use of half the dose of elemental calcium. These salts should be taken with meals in order to complex more dietary phosphate and decrease calcium absorption and therefore the risk of hypercalcemia. Oral calcium alone, without 1 alpha OH-vitamin D3 derivatives, can prevent hyperphosphatemia and hyperparathyroidism in most uremic patients before dialysis and in about half of the patients dialyzed with a dialysate calcium of 1.5 to 1.65 mmol/L. 1 alpha OH-vitamin D3 derivatives, which increase intestinal absorption of phosphate, should be used only when hyperphosphatemia has been prevented by oral calcium and diet and when plasma parathyroid hormone levels increase above three times the upper limit of normal. To decrease hypercalcemic risk, patients should be given 1 alpha OH-vitamin D3 derivatives, preferably at night, as an intermittent bolus (intravenous or oral). In dialysis patients, the dialysate concentration of calcium may have to be further decreased in order to prevent hypercalcemia when high doses of oral calcium are necessary to control hyperphosphatemia. SN - 1062-4821 UR - https://www.unboundmedicine.com/medline/citation/7859019/Management_of_hyperphosphatemia_in_patients_with_renal_failure_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=7859019.ui DB - PRIME DP - Unbound Medicine ER -