Hyperphosphatemia phosphorus restriction

The first-line treatment for the management of hyperphosphatemia is dietary phosphorus restriction to 800 to 1000 mg per day in patients with stage 3 CKD or higher who have phosphorus levels at the upper limit of the normal range or elevated iPTH levels.39 Foods high in phosphorus are also high in protein, which can make it difficult to restrict phosphorus intake while maintaining adequate protein intake to avoid... 

Management of hyperphosphatemia, calcium balance, and secondary hyperparathyroidism includes dietary phosphorus restriction, use of phosphate binding agents, and vitamin D therapy. 

Patients with CKD or ESKD often are treated for hyperphosphatemia with phosphorus-restricted diets and phosphate binding agents (see Chaps. 43 and 44). When these patients receive aggressive nutritional support, the combination of refeeding (cellular uptake of phosphorus for synthesis of body cell mass) and vigorous phosphatebinding therapy can result in hypophosphatemia. 

Hyperphosphatemia is common in patients with end-stage renal disease (ESRD), since a large fraction (60-70%) of dietary phosphorus is absorbed and normally excreted by the kidneys, and as kidney function deteriorates, less phosphorus is exereted by the kidneys (Emmett 2004). Dietary restrictions have insuffieient effect. The condition may have serious consequences. Hyperphosphatemia stimulates parathyroid hormone and suppresses vitamin D3 production, and thus induces hyperparathyroid bone disease. In addition, it leads to myocardial and vascular calcification and cardiac microcirculatory abnormalities, which results in cardiac causes of death. Phosphate levels henee should be eontrolled early in the... 

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