It is essential for the pharmacist to recognize that in the setting of advanced chronic kidney disease (CKD), dialysis does not remove all phosphorus as it does other electrolytes, and many patients will require a phosphate binder. ![]() Medications causing hyperphosphatemia include phosphorus-containing laxatives, oral phosphorus supplements, vitamin D supplements, and the bisphosphonates. Causes of hyperphosphatemia include impaired phosphorus excretion (renal failure or hypoparathyroidism), redistribution of phosphorus to the extracellular fluid (acid-base imbalance, rhabdomyolysis, muscle necrosis, or tumor lysis during chemotherapy), and increased phosphate intake. Hyperphosphatemia is defined by a serum phosphorus concentration of >4.5 mg/dL (1.45 mmol/L). Serum phosphorus concentration is normally 2.7 to 4.5 mg/dL (0.87-1.45 mmol/L). 1 It is a major anion and is used as the source for the synthesis of adenine triphosphate (ATP) and phospholipids. Phosphorus is an electrolyte found primarily in the bones (80%-85%) and in the intracellular fluid. Sucroferric oxyhydroxide and ferric citrate are calcium-free and may offer benefits in those with a high pill burden and in patients with concurrent anemia, respectively. In this situation, sevelamer and lanthanum have demonstrated a cardiovascular mortality benefit. In CKD stage 5, hypercalcemia can increase the risk of cardiovascular disease. ![]() Calcium-based products are often started in stage 4 secondary to efficacy, safety, and cost. Hyperphosphatemia in CKD stages 1 to 3 can typically be controlled with dietary changes. ![]() Recently, two iron-based phosphate binders have been approved. Adverse effects and toxicity limited the use of these agents, and therapy evolved with calcium carbonate, calcium acetate, sevelamer, and lanthanum carbonate. The first phosphate binders were aluminum- and magnesium-based antacids. The management of hyperphosphatemia has included dietary phosphate restriction and use of phosphate binders. ABSTRACT: Hyperphosphatemia is an abnormally high level of serum phosphate that contributes to chronic kidney disease (CKD).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |