[Treatment of hyperphosphatemia in hemodialysis patients].
Hyperphosphatemia plays a key role in the development of hyperparathyroidism and extraosseous calcification and is associated with increased mortality in hemodialysis patients. The treatment of hyperphosphatemia therefore represents a cornerstone in the management of dialyzed patients. NFK-KDOQI 2003 has recommended rigorous control of serum phosphorus to between 1.13-1.78 mmol/l. A multiple-factor approach can be used to reduce serum phosphate: 1) reduce phosphorous intake in the diet; 2) increase phosphate removal by dialytic treatment; 3) use old and new phosphate binders; 4) treat with nicotinamide; and 5) control serum parathyroid hormone levels. All these points are discussed in this review. Recent recommendations for supplemental elemental calcium restriction to 1.5 g per day are reconsidered and indications of new calcium-free phosphate binders are examined.
Rieu
Philippe
P
Service de néphrologie, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims, France. prieu@chu-reims.fr
D002118:Calcium / Q000097:blood; D004032:Diet; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology* / Q000601:surgery; D009536:Niacinamide / Q000627:therapeutic use; D016105:Parathyroidectomy; D010710:Phosphates / Q000378:metabolism*; D006435:Renal Dialysis / Q000009:adverse effects*
D010710:Phosphates; D009536:Niacinamide; D002118:Calcium