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State-of-the-Art Management of Hyperphosphatemia in Patients With CKD: An NKF-KDOQI Controversies Perspective.

Publication ,  Journal Article
Scialla, JJ; Kendrick, J; Uribarri, J; Kovesdy, CP; Gutiérrez, OM; Jimenez, EY; Kramer, HJ
Published in: Am J Kidney Dis
January 2021

Phosphate binders are among the most common medications prescribed to patients with kidney failure receiving dialysis and are often used in advanced chronic kidney disease (CKD). In patients with CKD glomerular filtration rate category 3a (G3a) or worse, including those with kidney failure who are receiving dialysis, clinical practice guidelines suggest "lowering elevated phosphate levels towards the normal range" with possible strategies including dietary phosphate restriction or use of binders. Additionally, guidelines suggest restricting the use of oral elemental calcium often contained in phosphate binders. Nutrition guidelines in CKD suggest<800-1,000mg of calcium daily, whereas CKD bone and mineral disorder guidelines do not provide clear targets, but<1,500mg in maintenance dialysis patients has been previously recommended. Many different classes of phosphate binders are now available and clinical trials have not definitively demonstrated the superiority of any class of phosphate binders over another with regard to clinical outcomes. Use of phosphate binders contributes substantially to patients' pill burden and out-of-pocket costs, and many have side effects. This has led to uncertainty regarding the use and best choice of phosphate binders for patients with CKD or kidney failure. In this controversies perspective, we discuss the evidence base around binder use in CKD and kidney failure with a focus on comparisons of available binders.

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Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

January 2021

Volume

77

Issue

1

Start / End Page

132 / 141

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Renal Insufficiency, Chronic
  • Renal Dialysis
  • Phosphates
  • Patient Care Management
  • Hyperphosphatemia
  • Humans
  • Clinical Trials as Topic
  • Chelating Agents
  • Calcium
 

Citation

APA
Chicago
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MLA
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Scialla, J. J., Kendrick, J., Uribarri, J., Kovesdy, C. P., Gutiérrez, O. M., Jimenez, E. Y., & Kramer, H. J. (2021). State-of-the-Art Management of Hyperphosphatemia in Patients With CKD: An NKF-KDOQI Controversies Perspective. Am J Kidney Dis, 77(1), 132–141. https://doi.org/10.1053/j.ajkd.2020.05.025
Scialla, Julia J., Jessica Kendrick, Jaime Uribarri, Csaba P. Kovesdy, Orlando M. Gutiérrez, Elizabeth Yakes Jimenez, and Holly J. Kramer. “State-of-the-Art Management of Hyperphosphatemia in Patients With CKD: An NKF-KDOQI Controversies Perspective.Am J Kidney Dis 77, no. 1 (January 2021): 132–41. https://doi.org/10.1053/j.ajkd.2020.05.025.
Scialla JJ, Kendrick J, Uribarri J, Kovesdy CP, Gutiérrez OM, Jimenez EY, et al. State-of-the-Art Management of Hyperphosphatemia in Patients With CKD: An NKF-KDOQI Controversies Perspective. Am J Kidney Dis. 2021 Jan;77(1):132–41.
Scialla, Julia J., et al. “State-of-the-Art Management of Hyperphosphatemia in Patients With CKD: An NKF-KDOQI Controversies Perspective.Am J Kidney Dis, vol. 77, no. 1, Jan. 2021, pp. 132–41. Pubmed, doi:10.1053/j.ajkd.2020.05.025.
Scialla JJ, Kendrick J, Uribarri J, Kovesdy CP, Gutiérrez OM, Jimenez EY, Kramer HJ. State-of-the-Art Management of Hyperphosphatemia in Patients With CKD: An NKF-KDOQI Controversies Perspective. Am J Kidney Dis. 2021 Jan;77(1):132–141.
Journal cover image

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

January 2021

Volume

77

Issue

1

Start / End Page

132 / 141

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Renal Insufficiency, Chronic
  • Renal Dialysis
  • Phosphates
  • Patient Care Management
  • Hyperphosphatemia
  • Humans
  • Clinical Trials as Topic
  • Chelating Agents
  • Calcium