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.