Too Much Phosphorus IsA Serious Concern For Chronic Kidney Disease Patients Hyperphosphatemia is a condition commonly seenamong chronic kidney disease (CKD) patients, in which phosphate levels shoot upabnormally high. This can result from varying factors like increase inphosphate intake, decrease in phosphate excretion, or a disorder that shiftsintracellular phosphate to extracellular space, but the health of our kidneysplay a crucial role as its kidneys that control the amount of phosphate in theblood. Phosphates are the naturally occurring form ofphosphorus and is the second most abundant element in the human body aftercalcium. And, similar to calcium, phosphates too require vitamin D for itsabsorption. However, abundance of phosphorus in chronic kidney disease patientsposes a serious concern as it lowers the calcium levels in the blood and cancause many other health ailments like cardiovascular calcification, metabolicbone disease and the development of secondary hyperparathyroidism (SHPT),etc. Generally phosphate is absorbed from digestedfood in the gut and in normal circumstances if there is higher than normalphosphate absorption, the kidneys are somehow able to cope with increasedexcretion. But if the kidney function gets hampered, even a moderately raisedphosphate absorption can lead to "hyperphosphatemia". And that's whythe patients on dialysis are commonly seen affected withhyperphosphatemia. Secondly, phosphate absorption can also beincreased with vitamin D which can lead to hyperphosphatemia through increasedgut absorption of phosphate. Some of the possible causes ofhyperphosphatemia due to excessive phosphate intake includes :* Intravenous injection of phosphate* Excessive intake of vitamin D through dietor supplements, etc* Acute phosphorus poisoning* Milk-alkali syndrome Decreased Elimination of PhosphateIf the elimination of phosphate through thekidneys are diminished, especially when there is a high intake of phosphate infoods, hyperphosphatemia may occur. This can be seen with kidney problems suchas acute or chronic renal failure. Parathyroid hormone (PTH) secreted by theparathyroid gland also contributes to regulation of phosphate. However, whenPTH levels are low, then there is increased reabsorption of phosphate leadingto retention. Therefore, hyperphosphatemia may arise with decreased PTH levels,called hypoparathyroidism. Some of the possible reasons ofhyperphosphatemia due to decreased elimination of phosphate includes :* Hypoparathyroidism* Kidney failure* Magnesium deficiency* Excess consumption of vitamin D* Use of bisphosphonates for osteoporosistreatment* Multiple myeloma Signs and Symptoms Occasionally patients with hyperphosphatemiareport hypocalcemic symptoms such as muscle cramps, numbness or tingling. Othersymptoms may include bone or joint pain, and rash, etc. More commonly, patientsreport symptoms related to the underlying cause of the hyperphosphatemia butthese generally are uremic symptoms, such as fatigue, shortness of breath,anorexia, nausea, vomiting, disturbed sleep, etc. Tests and Diagnosis Hyperphosphatemia is diagnosed with specificblood tests which measure the levels of :* Phosphate* Calcium* Magnesium* Blood urea nitrogen * Creatinine* Vitamin D* Parathyroid hormone (PTH) Treatment for Hyperphosphatemia Its important to diagnose and find theunderlying cause of hyperphosphatemia so as to treat and restore normalphospate metabolism. Various medication can help normalise the phosphate levelsin the blood. Dietary modification or consuming low phosphorus diet is alsonecessary especially in case of kidney patients. The medication used forhyperphosphatemia includes : * Phosphate binders which block the absorptionof phosphates from the gut. This includes Aluminum hydroxide, Calciumcarbonate, Calcium acetate, Magnesium hydroxide, Sevelamer hydrochloride,etc. * Loop diuretics help to increase phosphateexcretion through the kidneys. These drugs include Furosemide, Bumetanide,etc. Low Phosphate Diet A low phosphate diet is an important part ofthe treatment and management of hyperphosphatemia. Dietary change alone may besufficient to restore blood phosphate levels provided the kidneys functionefficiently. Foods that should be strictly avoided, or at least consumed inmoderation includes: manufactured drinks and foods such as soft drinks,chocolates, tinned milk, processed meat, processed cheese, ready-to-eat-meals,ice- creams, soups containing large quantity of beans, lentils, peas and milkwhich are high in phosphorus.Also, vegetables and legumes like asparagus,beans, broccoli, corn, mushrooms, pumpkin, spinach and sweet potato, etc.,should be consumed in restricted quantity. Even foods like meat, fish, softcheese like cottage cheese, mozzarella, etc., should not be consumed more thanone serving a month. However, it is advisable to consult a nephrologist orrenal dietician before making any major diet changes. Therefore, multiple strategies can beimplemented to control phosphate homeostasis in patients with CKD. Besidesdietary restriction, removal of phosphates via dialysis or intensive (nocturnalor short daily) dialysis regimens can also be implemented, this modality oftreatment often proves beneficial.