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How to treat hyperphosphatemia in dialysis patients?

2017-11-17 17:46

Hyperphosphatemia refers to serum phosphorus levels exceeding 4.5mg/dl. At present, there are three main aspects of the control of hyperphosphatemia in dialysis patients, including adequate hemodialysis, dietary restriction and the use of phosphate binders.

How to treat hyperphosphatemia in dialysis patients?

Adequate hemodialysis

Prolonged dialysis time or short daily dialysis or daily nocturnal dialysis can control blood phosphorus to target level, which is helpful to control hyperphosphatemia. However, most of the phosphorus entering the body exists in human cells, so hemodialysis can only remove a small amount of phosphorus, and sometimes can not effectively control hyperphosphatemia. However, compared with conventional hemodialysis, hemodiafiltration can significantly increase the clearance of phosphorus, and increase the membrane area and speed of blood flow can also increase the clearance of phosphorus.

Dietary restriction

For non dialysis patients with chronic renal failure, the reduction of phosphorus intake through diet restriction is one of the feasible methods to control hyperphosphatemia. But need to eat a high protein diet has entered for hemodialysis patients, so increasing the phosphorus intake, dietary restriction of reducing phosphorus may improve hyperphosphatemia related hyperparathyroidism, but low phosphorus diet to maintain adequate nutrition and adequate protein intake is unfavorable. Malnutrition and lack of protein intake are common in dialysis patients, which is one of the major risk factors leading to increased mortality. At the same time, even the most stringent phosphorus restriction diet, 600mg phosphorus is still in the body every day. Therefore, we should not rely too much on dietary restriction to reduce phosphorus intake. First of all, adequate nutrition intake should be ensured.

Application of phosphate binder

Because of dialysis and dietary restriction can not effectively control hyperphosphatemia, the use of phosphate binders becomes the main method to reduce blood phosphorus. A variety of compounds are used to combine phosphorus in the diet to reduce the absorption of phosphorus in the gut and increase the amount of excretion from the feces. Such as calcium carbonate and calcium acetate is currently in clinical use of phosphate binders most widely, these two kinds of calcium salts after use can make the blood phosphorus have decreased to some extent, and can supplement calcium deficiency, correct hypocalcemia, hyperphosphatemia is correct and secondary hyperparathyroidism is effective method. And the relevant research shows that calcium phosphate is better than calcium carbonate in pH<6.0. Studies have also shown that calcium acetate can better bind phosphorus in food than calcium carbonate under the same calcium content.

 

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