Why is Monitoring Phosphorus Important in
Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD) and Dialysis?

10 Things ESRD CKD and Dialysis patients need to know about Phosporus:

  1. Phosphorus is a very common and important mineral element in the body, symbol P.

  2. Phosphorus is found in meat, dairy products, dark cola (non translucent), beans, nuts, and in some food additives, especially in processed foods.

  3. Phosphorus is important in bone metabolism and in maintaining the proper pH (acidity) of the blood stream.

  4. When Phosphorus is combined with oxygen, it is called phosphate.

  5. Healthy kidneys maintain a proper level of blood Phosphorus by eliminating excessive Phosphorus in the urine.

  6. Patients with ESRD and CKD can retain too much phosphorus, called hyperphosphatemia.

  7. High levels of phosphorus combine (bind) with Calcium. Calcium can come out of the bones and lead to weak bones (renal osteodystrophy). The Phosphorus-Calcium complexes can also be deposited into organs and blood vessels, leading to hardening of these organs.

  8. CKD, ESRD, Dialysis and Hemodialysis patients are counseled to follow a diet that limits the amount of phosphorous-containing foods they eat.

  9. CKD, ESRD, Dialysis and Hemodialysis patients are often prescribed phosphorus-binding medications. Phosphorus-binding medications are usually taken before meals to help prevent phosphorus from being absorbed from the intestines.

  10. Dialysis patients have their blood level of phosphorus measured every month to keep the phophorus level in the appropriate range.

    If you are a CKD, ESRD, Dialysis and Hemodialysis, talk to your renal dietician and kidney health care providers about ways to control your phosphorus levels.
    November 13 2012

    Phosphate Binders | Phosphorus | Phosphate | Studies in ESRD CKD and Dialysis

    Hemodialysis.com: Rudolf P. Wüthrich, MD, FACP, FASN

    Randomized Clinical Trial of the Iron-Based Phosphate Binder PA21 in Hemodialysis Patients

    Wüthrich RP, Chonchol M, Covic A, Gaillard S, Chong E, Tumlin JA.
    Division of Nephrology, University Hospital, Zürich, Switzerland;, †Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado;, ‡Nephrology Clinic, Dr. C. I. Parhon University Hospital, University of Medicine Grigore T Popa, Iasi, Romania;, §Vifor Pharma, Glattbrugg, Switzerland;, ?Vifor Pharma, Victoria, British Columbia, Canada, ¶University of Tennessee College of Medicine, Chattanooga, Tennessee.
    Clin J Am Soc Nephrol. 2012 Nov 2. [Epub ahead of print]

    Hemodialysis.com Author Interview: Dr. Jing Chen

    Association of Circulating Fibroblast Growth Factor-23 with Renal Phosphate Excretion among Hemodialysis Patients with Residual Renal Function

    Mengjing Wang, Li You, Haiming Li, Yong Lin, Zhijie Zhang, Chuanming Hao, and Jing Chen

    CJASN CJN.00230112; published ahead of print October 18, 2012

    Hemodialysis.com Author Interview: Thomas Alfieri, PhD

    Title:  Reasons for Phosphate Binder Discontinuation Vary by Binder Type
    Authors:  Thomas Alfieri, PhD,1 Steven Wang, PhD,1 Peter Braunhofer, MS,2 Britt Newsome, MD, MPH, MSPH3 
    Affiliations:  1DaVita Inc, Denver, CO; 2Vifor Pharma, Glattbrugg, Switzerland; 3Denver Nephrology, Denver, CO

    Hemodialysis.com Author Interview: Mario Cozzolino, MD, PhD

    Phosphate handling in CKD-MBD from stage 3 to dialysis and the three strengths of lanthanum carbonate

    Cozzolino M, Bruschetta E, Cusi D, Montanari E, Giovenzana ME, Galassi A.
    Renal Division and Laboratory of Experimental Nephrology, Dipartimento di Scienze della Salute, UniversitÓ di Milano, Renal Division, S. Paolo Hospital , Via A. di Rudiný, 8 - 20142, Milan , Italy
    Expert Opin Pharmacother. 2012 Oct 4. [Epub ahead of print]

    Hemodialysis.com Author Interview: Lisa Bernard
    Cornerstone Research Group Inc

    A modeled economic evaluation of sevelamer for treatment of hyperphosphatemia associated with chronic kidney disease among patients on dialysis in the United Kingdom

    Bernard L, Mendelssohn D, Dunn E, Hutchison C, Grima DT.
    J Med Econ. 2012 Aug 2. [Epub ahead of print] PMID:22857538

    Hemodialysis.com Author Interview: Dr. Geoffrey A. Block

    Effects of Phosphate Binders in Moderate CKD.

    Block GA, Wheeler DC, Persky MS, Kestenbaum B, Ketteler M, Spiegel DM, Allison MA, Asplin J, Smits G, Hoofnagle AN, Kooienga L, Thadhani R, Mannstadt M, Wolf M, Chertow GM.
    Denver Nephrology, 130 Rampart Way, Suite 300b, Denver, CO 80230. gablock@denverneph.net.
    J Am Soc Nephrol. 2012 Aug;23(8):1407-15. Epub 2012 Jul 19.

    Hemodialysis.com Author Interview: Dr. José H. Rocco Suassuna

    Phosphate Mass Removal during Hemodialysis: A Comparison between eKT/V-Matched Conventional and Extended Dialysis.

    Sampaio MS, Ruzany F, Dorigo DM, Suassuna JH.
    Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.
    Am J Nephrol. 2012 Jul 7;36(2):121-126.
    [Epub ahead of print]

    More on Phosphate Binders in CKD and Dialysis

    Iron-Based Phosphate Binder PA21: Effective and Well Tolerated in CKD Hemodialysis Patient

    Michel Chonchol1, Rudolf P. Wüthrich, Viatcheslav Rakov, Sylvain Gaillard, James A. Tumlin.
    University of Colorado, CO, USA 

    Spring 2012 NKF Meeting

    Author Interview: Dr. Gary E. Striker

    Effect of Sevelamer on HbA1c, Inflammation, and Advanced Glycation End Products in Diabetic Kidney Disease

    • Helen Vlassara, Jaime Uribarri, Weijing Cai, Susan Goodman, Renata Pyzik,James Post, Fabrizio Grosjean, Mark Woodward, and Gary E. Striker

       CJN.12891211; published ahead of print March 29, 2012,doi:10.2215/CJN.12891211

    Astellas Pharma : Obtains Approval in Japan for Treating Hyperphosphatemia in Dialysis Patients with Kiklin® Capsules

    03/30/2012 |

    Tokyo, March 30, 2012 - Astellas Pharma Inc. ("Astellas Pharma"; Tokyo:4503; President and CEO: Yoshihiko Hatanaka) announced that Kiklin® Capsules (development code: ASP1585, generic name:Bixalomar) were granted Japanese marketing approval today for the indication of hyperphosphatemia in patients on dialysis with chronic kidney disease.

    Author Interview: Dr. Jing Chen  

    Phosphate removal model: An observational study of low-flux dialyzers in conventional hemodialysis therapy

    Wang, M., Li, H., Liao, H., Yu, Y., You, L., Zhu, J., Huang, B., Yuan, L., Hao, C. and Chen, J. (2012), Phosphate removal model: An observational study of low-flux dialyzers in conventional hemodialysis therapy. Hemodialysis International. doi: 10.1111/j.1542-4758.2012.00678.x

    Biagio Di Iorio, Lucia Di Micco, Serena Torraca, Maria Luisa Sirico, Luigi Russo, Andrea Pota, Francesco Mirenghi, and Domenico Russo

    Acute Effects of Very-Low-Protein Diet on FGF23 Levels: A Randomized StudyCJASN CJN.07640711; published ahead of print February 23, 2012,doi:10.2215/CJN.07640711

    Author Interview: Mohammed. S. Razzaque, MBBS, PhD, FASN

    Lack of Awareness among Future Medical Professionals about the Risk of Consuming Hidden Phosphate-Containing Processed Food and Drinks. 

    Shutto Y , Shimada M , Kitajima M , Yamabe H , Razzaque MS , 

    PLoS ONE 6(12): 2011
    e29105. doi:10.1371/journal.pone.0029105

    Author Interview: Jamie Heise Pharm. D, BCPS

    ASN Abstract: [FR-PO1205] Phosphorus (P) Management Trends of Hemodialysis Patients in a Large Dialysis Organization

    Jamie Heise, PharmD, Kamyar Kalantar-Zadeh, MD, PhD, FASN, John Brian Copley, MD, FASN, Moshe Fridman, PhD, Rajnish Mehrotra, MD, FASN. Medical Affairs, Shire Pharmaceuticals, Chesterbrook, PA; Nephrology, Harbor- UCLA Medical Center, Torrance, CA; Statistics, AMF Consulting, Los Angeles, CA.

    Dr. Sinee Disthabanchong

    Renal Phosphate Loss in Long-Term Kidney Transplantation

    Supinda Sirilak, Kamonwan Chatsrisak, Atiporn Ingsathit, Surasak Kantachuvesiri, Vasant Sumethkul, Wasana Stitchantrakul, Piyanuch Radinahamed, and Sinee Disthabanchong

    CJASN December 1, 2011 CJN.06380611; published ahead of print December 1, 2011

    Author Interview: Drs. Marcelo Sampaio and Kam Kalantar-Zadeh

    Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

    Marcelo S. Sampaio,  Miklos Z. Molnar, Csaba P. Kovesdy, Rajnish Mehrotra, Istvan Mucsi, John J. Sim, Mahesh Krishnan, Allen R. Nissenson, and Kamyar Kalantar-Zadeh
    CJASN September 29, 2011

    Author Interview: Dr. Kuo-Cheng Lu, MD

    Decreased blood lead levels after calcitriol treatment in hemodialysis patients with secondary hyperparathyroidism.
    Lu KC, Wu CC, Ma WY, Chen CC, Wu HC, Chu P.
    Bone. 2011 Oct 1. [Epub ahead of print]
    Division of Nepheology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

    Author Interview: Dr. Melani Ribeiro Custodio

    Parathyroid hormone and phosphorus overload in uremia: impact on cardiovascular system

    Melani R. Custódio, Marcia K. Koike, Katia R. Neves, Luciene M. dos Reis, Fabiana G. Graciolli, Carolina L. Neves, Daniella G. Batista, Andrea O. Magalhães, Philippe Hawlitschek, Ivone B. Oliveira, Wagner V. Dominguez, Rosa M.A. Moysés,  and Vanda Jorgetti
    Nephrol. Dial. Transplant. (2011)first published online August 8, 2011 doi:10.1093/ndt/gfr447

    Author Interview:  Dr. David Pierce, Ph.D.
    The effect of sevelamer carbonate and lanthanum carbonate on the pharmacokinetics of oral calcitriol.

    Pierce D, Hossack S, Poole L, Robinson A, Van Heusen H, Martin P, Smyth M.
    Nephrol Dial Transplant. 2011 May;26(5):1615-21
    Author Interview Dr. David Mudge
    Does aluminium continue to have a role as a phosphate binder in contemporary practice?

    David W Mudge , David W Johnson ,Carmel M Hawley, Scott B Campbell, Nicole M Isbel
    Carolyn L van Eps and James JB Petrie

    BMC Nephrology2011, 12:20doi:10.1186/1471-2369-12-20
    Author Interview: Dr. Ken-ichi Miyamoto Ph.D
    Sodium-dependent phosphate cotransporters: Lessons from gene knockout and mutation studies

    Miyamoto KI, Haito-Sugino S, Kuwahara S, Ohi A, Nomura K, Ito M, Kuwahata M, Kido S, Tatsumi S, Kaneko I, Segawa H.
    J Pharm Sci. 2011 May 12. doi: 10.1002/jps.22614
    Author Interivew: John Sim, MD

    John J. Sim, Ning Smith, Joanie Chung, Eric Yan, Simran Bhandari,
    Scott Rasgon, Kam Kalantar-Zadeh                                               
    Kaiser Permanente Los Angeles Medicial Center
    Author Interview: Dr. E. González Parra Lanthanum carbonate reduces FGF23 in chronic kidney disease stage 3 patients.

    Gonzalez-Parra E, Gonzalez-Casaus ML, Galán A, Martinez-Calero A, Navas V, Rodriguez M, Ortiz A.1IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.

    Author Interview: Dr. Carl Kjellstrand

    Phosphorus dynamics during hemodialysis.

    Hemodial Int. 2011 Feb 25. doi: 10.1111/j.1542-4758.2011.00538.x.
    Kjellstrand CM, Ing TS, Kjellstrand PT, Odar-Cederlof I, Lagg CR.
    Hines VA/Loyola University Chicago, Chicago, Illinois, USA Karolinska Institute, Stockholm, Sweden Department of Biology, Lund University, Lund, Sweden Northwest Kidney Centers, University of Washington, Seattle, Washington, USA

    Author Interview: Dr. Takatoshi Kakuta:

    Effect of sevelamer and calcium-based phosphate binders on coronary artery calcification and accumulation of circulating advanced glycation end products in hemodialysis patients

    Am J Kidney Dis. 2011 Mar;57(3):422-31.
    Kakuta T, Tanaka R, Hyodo T, Suzuki H, Kanai G, Nagaoka M, Takahashi H, Hirawa N, Oogushi Y, Miyata T, Kobayashi H, Fukagawa M, Saito A.

    Division of Nephrology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan.

    Serum phosphorus predicts incident chronic kidney disease and end-stage renal disease.

    Nephrol Dial Transplant. 2011 Feb 8.
    O'Seaghdha CM, Hwang SJ, Muntner P, Melamed ML, Fox CS.
    1National Heart, Lung and Blood Institute's Framingham Heart Study and the Center for Population Studies, Framingham, USA.

    BACKGROUND: Elevations in serum phosphorus are associated with renal decline in animal models and progression of established chronic kidney disease (CKD) in human observational studies. We examined whether serum phosphorus levels increase the risk of incident CKD or end-stage renal disease (ESRD) in two population-based prospective cohort studies.

    Vegetarian Compared with Meat Dietary Protein Source and Phosphorus Homeostasis in Chronic
    Kidney Disease

    Sharon M. Moe Miriam P. Zidehsarai, Mary A. Chambers, Lisa A. Jackman, J. Scott Radcliffe, Laurie L. Trevino,
    Susan E. Donahue and John R. Asplin
    Clin J Am Soc Nephrol 6: , 2011. doi: 10.2215/CJN.05040610

    Phosphate-binding efficacy of crushed vs. chewed lanthanum carbonate in hemodialysis patients.

    Hemodial Int. 2010 Dec 7.
    doi: 10.1111/j.1542-4758.2010.00509.x.

    How PP, Anattiwong P, Mason DL, Arruda JA, Lau AH.
    Departments of Pharmacy PracticeMedicine, Section of Nephrology, University of Illinois at Chicago, Chicago, Illinois,

    Lanthanum carbonate, a chewable noncalcium-containing phosphorus (P) binder, is useful for treating secondary hyperparathyroidism in patients who have hypercalcemia and cannot swallow whole tablets


    Doctors’ Recommendation Needs Reconsideration 

    Washington, DC (Monday, December 6, 2010) — Doctors often ask kidney disease
    patients on dialysis to limit the amount of phosphate they consume in their diets, but this
    does not help prolong their lives, according to a study appearing in an upcoming issue
    of the Clinical Journal of the American Society Nephrology (CJASN). The results even
    suggest that prescribing low phosphate diets may increase dialysis patients’ risk of
    premature death

    Three-year extension study of lanthanum carbonate therapy in Japanese hemodialysis patients.

    Clin Exp Nephrol. 2010 Sep 4

    Shigematsu T; The Lanthanum Carbonate Research Group.
    Division of Nephrology and Blood Purification Medicine, Department of Medicine, Wakayama Medical University, 881-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan

    Does the choice of phosphate binder affect trace element levels in chronic kidney disease patients treated by regular haemodialysis?

    Nephrol Dial Transplant. 2010 Aug 24.

    Veighey K, Booth J, Davenport A.
    UCL Center for Nephrology, Royal Free Campus, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK.

    Serum Phosphate and Mortality in Patients with Chronic Kidney Disease.

    Clin J Am Soc Nephrol. 2010 Aug 5.
    Eddington H, et al
    Salford Royal NHS Foundation Trust, Salford, United Kingdom; and.

    Dietary phosphate restriction in dialysis patients: A new approach for the treatment of hyperphosphataemia.
    Nutr Metab Cardiovasc Dis. 2010 Jul 5.
    Guida B, et al
    Department of Neuroscience, Physiology Nutrition Unit, University Federico II, Naples, Italy.

    Genetic Disorders of Renal Phosphate Transport
    Dominique Prié, M.D., Ph.D., and Gérard Friedlander, M.D., Ph.D.
    NEJM Volume 362:2399-2409 June 24 2010 Number 25

    Phosphate removal with several thrice-weekly dialysis methods in overweight hemodialysis patients.
    Am J Kidney Dis. 2009 Dec;54(6):1108-15.
    Tonelli M, et al Alberta Kidney Disease Network.
    Department of Medicine, University of Alberta, Edmonton, Canada

    Phosphate elimination in modalities of hemodialysis and peritoneal dialysis.

    Blood Purification. 2010;29(2):137-44.
    Kuhlmann MK.
    Department of Internal Medicine - Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany. martin.kuhlmann@vivantes.de



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