Kidney Week Educational Symposia-Management of Hyperphosphatemia in Patients with ESKD, Especially During the COVID-19 Pandemic

Video Transcription

Video Summary

This symposium reviewed hyperphosphatemia management in end-stage kidney disease (ESKD), with added considerations during the COVID-19 pandemic. The moderator introduced phosphate physiology, noting normal serum phosphate (2.5–4.5 mg/dL), diurnal variation, and that hyperphosphatemia typically develops as GFR falls below ~30–40 mL/min/1.73m² and is common in ESKD without treatment. Phosphate balance depends on intestinal absorption, renal handling, tissue exchange, and hormones (calcitriol, PTH, FGF23/klotho). In dialysis patients, key determinants are intestinal phosphate influx and dialysis removal.<br /><br />Management rests on three “D’s”: Diet, Dialysis, and Drugs. Dietary counseling focuses on limiting phosphate intake and choosing lower-bioavailability sources (plant-based/phytate-bound) while avoiding highly absorbable inorganic phosphate additives; label-reading and telehealth diet interventions reduced phosphate in studies. More frequent dialysis improves phosphate control.<br /><br />Phosphate binders (calcium-based, sevelamer, lanthanum, iron-based agents) lower absorption but often cause GI side effects; aluminum binders are avoided due to toxicity. Trials comparing binders (e.g., lanthanum vs calcium) have not shown clear cardiovascular superiority. Observational COVID-era ICU data linked higher phosphate with mortality, and disasters can worsen control by disrupting dialysis and diet. New non-binder approaches (e.g., tenapanor, other transport inhibitors) and large target-phosphate trials (HILO, PHOSPHATE) aim to clarify causality and optimal goals.

Asset Subtitle

Moderators: Elvira Gosmanova

Introduction: Phosphate Homeostasis and Hyperphosphatemia Management - Elvira Gosmanova
Update on Hyperphosphatemia Management in Patients with ESKD, Especially During the COVID-19 Pandemic - Michal Melamed
Organ Cross-Talk in Phosphate Homeostasis - Sharon Moe

Support is provided by an educational grant from Fresenius Medical Care.

Meta Tag

Date 11/3/2022

Pathway 1 Fluid, Electrolyte, and Acid-Base Disorders

Pathway 2 Bones, Stones, and Mineral Metabolism

Session ID 439796

Session Type ES - Educational Symposium

Keywords

hyperphosphatemia

end-stage kidney disease

phosphate management

dialysis phosphate removal

dietary phosphate restriction

phosphate binders

FGF23 klotho PTH calcitriol

COVID-19 pandemic considerations

tenapanor