Hyperphosphatemia

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

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

Elevated phosphate levels

Blood chemistry abnormalities are those of the underlying disease

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