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Managing Phosphate Burden in Patients Receiving Dialysis: Beyond Phosphate Binders and Diet

Most patients receiving dialysis rely on dietary restriction and phosphate binders to minimize the risk of hyperphosphatemia, which is associated with increased mortality. However, dietary restriction is difficult because of hidden phosphate additives in processed foods and medications. Restriction...

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Autores principales: Kalantar-Zadeh, Kamyar, Forfang, Derek, Bakris, George, Martin, Kevin J., Moe, Sharon M., Sprague, Stuart M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Nephrology 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10695651/
https://www.ncbi.nlm.nih.gov/pubmed/37870525
http://dx.doi.org/10.34067/KID.0000000000000262
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author Kalantar-Zadeh, Kamyar
Forfang, Derek
Bakris, George
Martin, Kevin J.
Moe, Sharon M.
Sprague, Stuart M.
author_facet Kalantar-Zadeh, Kamyar
Forfang, Derek
Bakris, George
Martin, Kevin J.
Moe, Sharon M.
Sprague, Stuart M.
author_sort Kalantar-Zadeh, Kamyar
collection PubMed
description Most patients receiving dialysis rely on dietary restriction and phosphate binders to minimize the risk of hyperphosphatemia, which is associated with increased mortality. However, dietary restriction is difficult because of hidden phosphate additives in processed foods and medications. Restriction of dietary phosphate sources such as protein may increase the risk of malnutrition. Phosphate binders, the only pharmacologic option for phosphate management since aluminum salts were introduced several decades ago, are often insufficient for binding the 1400–2500 mg of phosphate potentially consumed daily. Over the last decade, serum phosphate levels in the United States have risen, and >69% of patients receiving dialysis exhibited a most recent phosphate level >4.5 mg/dl (above the normal range), indicating an urgent need for new, more effective therapies to manage phosphate burden. Novel, nonbinder therapies such as transcellular and paracellular phosphate absorption inhibitors may be used for phosphate management, and future studies should examine whether they allow fewer dietary restrictions for patients receiving dialysis, potentially improving patient quality of life and nutritional status. It is imperative that we collaborate to move beyond the restrictive approaches available today and provide patients and clinicians with an array of strategies so that they may choose the most appropriate patient-centered therapy.
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spelling pubmed-106956512023-12-05 Managing Phosphate Burden in Patients Receiving Dialysis: Beyond Phosphate Binders and Diet Kalantar-Zadeh, Kamyar Forfang, Derek Bakris, George Martin, Kevin J. Moe, Sharon M. Sprague, Stuart M. Kidney360 Review Article Most patients receiving dialysis rely on dietary restriction and phosphate binders to minimize the risk of hyperphosphatemia, which is associated with increased mortality. However, dietary restriction is difficult because of hidden phosphate additives in processed foods and medications. Restriction of dietary phosphate sources such as protein may increase the risk of malnutrition. Phosphate binders, the only pharmacologic option for phosphate management since aluminum salts were introduced several decades ago, are often insufficient for binding the 1400–2500 mg of phosphate potentially consumed daily. Over the last decade, serum phosphate levels in the United States have risen, and >69% of patients receiving dialysis exhibited a most recent phosphate level >4.5 mg/dl (above the normal range), indicating an urgent need for new, more effective therapies to manage phosphate burden. Novel, nonbinder therapies such as transcellular and paracellular phosphate absorption inhibitors may be used for phosphate management, and future studies should examine whether they allow fewer dietary restrictions for patients receiving dialysis, potentially improving patient quality of life and nutritional status. It is imperative that we collaborate to move beyond the restrictive approaches available today and provide patients and clinicians with an array of strategies so that they may choose the most appropriate patient-centered therapy. American Society of Nephrology 2023-10-23 /pmc/articles/PMC10695651/ /pubmed/37870525 http://dx.doi.org/10.34067/KID.0000000000000262 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Review Article
Kalantar-Zadeh, Kamyar
Forfang, Derek
Bakris, George
Martin, Kevin J.
Moe, Sharon M.
Sprague, Stuart M.
Managing Phosphate Burden in Patients Receiving Dialysis: Beyond Phosphate Binders and Diet
title Managing Phosphate Burden in Patients Receiving Dialysis: Beyond Phosphate Binders and Diet
title_full Managing Phosphate Burden in Patients Receiving Dialysis: Beyond Phosphate Binders and Diet
title_fullStr Managing Phosphate Burden in Patients Receiving Dialysis: Beyond Phosphate Binders and Diet
title_full_unstemmed Managing Phosphate Burden in Patients Receiving Dialysis: Beyond Phosphate Binders and Diet
title_short Managing Phosphate Burden in Patients Receiving Dialysis: Beyond Phosphate Binders and Diet
title_sort managing phosphate burden in patients receiving dialysis: beyond phosphate binders and diet
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10695651/
https://www.ncbi.nlm.nih.gov/pubmed/37870525
http://dx.doi.org/10.34067/KID.0000000000000262
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