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

Key Features

  • Advanced CKD is the most common cause

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

  • 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)

Diagnosis

  • Elevated phosphate levels

  • Blood chemistry abnormalities are those of the underlying disease

Treatment

  • Treatment is directed at the underlying disorder

  • 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

  • Dietary phosphate absorption can be reduced by oral phosphate binders, such as

    • Calcium carbonate

    • Calcium acetate

    • Sevelamer carbonate

    • Lanthanum carbonate

    • Aluminum hydroxide

  • 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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