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For further information, see CMDT Part 21-11: Hyperphosphatemia

Key Features

  • Serum phosphate > 4.5 mg/dL (> 1.45 mmol/L)

  • Main cause is advanced chronic kidney disease (CKD) with insufficient urinary excretion of phosphorus

  • Hyperphosphatemia in the presence of hypercalcemia imposes a high risk of metastatic calcification

Clinical Findings

  • Symptoms are those of the underlying disorders (eg, CKD, hypoparathyroidism)

  • Inadequately treated hyperphosphatemia in CKD leads to

    • Secondary hyperparathyroidism

    • Renal osteodystrophy

    • Extraosseous calcification of soft tissues


  • Serum phosphate > 4.5 mg/dL (> 1.45 mmol/L)

  • In addition to elevated phosphate, blood chemistry abnormalities are those of the underlying disease


  • Treatment is that of the underlying disorder and of associated hypocalcemia if present

  • Exogenous sources of phosphate, including enteral or parenteral nutrition and medications, should be reduced or eliminated

  • In acute kidney injury and CKD, dialysis will reduce serum phosphate

  • Phosphate binders (eg, calcium carbonate and sevelamer hydrochloride) reduce phosphate absorption

  • Sevelamer, lanthanum, and aluminum may be used in patients with concomitant hypercalcemia, although aluminum use should be limited to a few days because of the risk of aluminum accumulation and neurotoxicity

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