title: Phosphate control in end-stage renal disease: barriers and opportunities.
abstract: Hyperphosphatemia is a nearly universal complication of end-stage renal disease that is widely recognized as one of the most important and most challenging clinical targets to meet in the care of dialysis patients. Left untreated, it can lead to bone pain, pruritus and worsening secondary hyperparathyroidism. Data from observational studies demonstrate that an elevated serum phosphorus level is an independent risk factor for mortality, and that treatment with phosphate binders is independently associated with improved survival. Experimental studies provide support for the epidemiologic findings: phosphate excess promotes vascular calcification, induces endothelial dysfunction and may contribute to other emerging chronic kidney disease-specific mechanisms of cardiovascular toxicity. On the basis of this evidence, clinical practice guidelines recommend specific targets for serum phosphorus levels in the dialysis population. The purpose of this review is to summarize common challenges in meeting these targets and to identify potential opportunities for improvement.
authors.affiliation: The Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Waheed
authors.forename: Fernando
authors.initials: F
authors.lastname: Pedraza
authors.forename: Oliver
authors.initials: O
authors.lastname: Lenz
authors.forename: Tamara
authors.initials: T
authors.lastname: Isakova
mesh_terms: D006801:Humans; D054559:Hyperphosphatemia / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy; D010710:Phosphates / Q000378:metabolism*
chemical_list: D010710:Phosphates
keywords: dialysis; phosphate binders; phosphorus
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