Speaker discusses other options for hyperphosphatemia in patients on dialysis
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Phosphate binders are not the only way to lower phosphorous levels in patients on dialysis with hyperphosphatemia, according to a speaker at the virtual Annual Dialysis Conference.
According to Kamyar Kalantar-Zadeh, MD, MPH, PhD, phosphate binders are the only therapeutic class of agents for treating hyperphosphatemia. The treatment binds dietary phosphate and limits meals while requiring patients to take “many large pills,” Kalantar-Zadeh, chief of nephrology at the University of California Irving, said.
“So, what can we do beyond binders?” he asked during the presentation.
One method is to increase the frequency or duration of a patient’s dialysis, he said. Additionally, Kalantar-Zadeh suggested researchers take another look at paracellular pathways because these are the primary mechanism for phosphorous absorption into the gastrointestinal tract.
Another option is to put patients on a low phosphorous diet of less than 1,000 mg per day. However, this strategy comes with obstacles such as the lack of phosphorous labels on food products and varying phosphorous levels in food depending on brand, Kalantar-Zadeh said.
Phosphorous does not just come from food; it also comes from the body, he said. Kalantar-Zadeh noted that lowering parathyroid hormones “is a highly effective way to lower phosphorous release in internal storage” rather than to deny patients specific foods.
“We should stop blaming patients for high phosphorus levels, and we should start blaming ourselves. We should not imply, even indirectly, that a patient’s phosphorus is high because of them,” Kalantar-Zadeh said in the presentation. “That era should be officially over, and we should work together — team up — to view phosphorous in the best interest of our patients while patients enjoy eating high protein foods, especially those on dialysis.”
Another method that may reduce phosphorous levels in patients is treatment with tenapanor. Kalantar-Zadeh referenced a study that found greater reduction in phosphorous levels among patients with hyperphosphatemia after treatment with tenapanor and binders than with binders alone.
“New phosphorous metric burdens and novel strategies to lower phosphorous burdens are needed that are patient friendly,” Kalantar-Zadeh concluded.
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Kalantar-Zadeh K. Moving beyond phosphate binders: Is it possible? Presented at: Annual Dialysis Conference; March 4-6, 2022 (virtual meeting).
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