Understanding and managing hyperphosphatemia in patients with chronic renal disease

Citation
Hh. Malluche et Mc. Monier-faugere, Understanding and managing hyperphosphatemia in patients with chronic renal disease, CLIN NEPHR, 52(5), 1999, pp. 267-277
Citations number
90
Language
INGLESE
art.tipo
Review
Categorie Soggetti
Urology & Nephrology","da verificare
Journal title
CLINICAL NEPHROLOGY
ISSN journal
0301-0430 → ACNP
Volume
52
Issue
5
Year of publication
1999
Pages
267 - 277
Database
ISI
SICI code
0301-0430(199911)52:5<267:UAMHIP>2.0.ZU;2-U
Abstract
Controlling serum phosphorus levels continues to be a challenge in patients with chronic renal disease. Hyperphosphatemia is implicated in the develop ment and worsening of secondary hyperparathyroidism and renal osteodystroph y (ROD) through its effects on serum calcium and calcitriol levels, parathy roid hormone (PTH) overproduction, and parathyroid cell hyperplasia. In the past serum phosphorus control with aluminum-containing phosphate binders w as associated with insidious but serious development of aluminum toxicity. More recent approaches using non aluminum-containing calcium salts as phosp hate binders are limited because of the excessive calcium load resulting fr om concomitant enhanced intestinal calcium absorption. Moreover serum phosp horus does not only result from dietary phosphate intake but also from enha nced bone breakdown due to secondary hyperparathyroidism. Strategies for ma naging ROD including early control of serum phosphorus and PTH, prevention of parathyroid hyperplasia; establishment of optimal PTH levels for bone he alth, and the availability of new therapeutic tools for controlling phospho rus may help prevent complications and improve patient outcomes.