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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Society of Nephrology
2023
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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. |
format | Online Article Text |
id | pubmed-10695651 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | American Society of Nephrology |
record_format | MEDLINE/PubMed |
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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