Management of hyperphosphatemia in adults with chronic kidney disease

CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; PTH: parathyroid hormone.

* Refer to UpToDate content on the management of hyperphosphatemia in adults with CKD for details.

¶ Refer to UpToDate content on prescribing and assessing adequate hemodialysis and prescribing peritoneal dialysis for details.

Δ The frequency of serum phosphorus measurements depends on the eGFR and whether baseline abnormalities are present or therapeutic measures have been taken. Refer to UpToDate content on the management of hyperphosphatemia in adults with CKD for details.

◊ For most patients, we suggest that non-calcium-containing binders be used. Choose agent based on affordability to patient, side effects, and preference (eg, pill burden, chew versus swallow).

§ Patients with nondialysis CKD and hyperphosphatemia should not be treated with calcitriol or active vitamin D analogs since these agents increase the gastrointestinal absorption of phosphate. We do not use calcimimetics (eg, cinacalcet) to lower PTH in patients with nondialysis CKD. In patients on dialysis who have refractory hyperphosphatemia and who are being treated for hyperparathyroidism, we use calcimimetics to suppress PTH and minimize the use of calcitriol or vitamin D analogs. Refer to UpToDate content on management of secondary hyperparathyroidism for details.