VIDEO: Biggest treatment challenges for patients with hyperphosphatemia

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We don’t really give enough dialysis to control phosphorus. I should probably start with that. We have gotten better at the size of the dialyzer that removes phosphorous a bit more than in the past. Some groups in some countries use more hemodiafiltration, which is more efficient for phosphorus removal. But really, patients should be on dialysis probably at least 4 days a week to have far better phosphorus control. So that leads to the next barrier, which is diet.

We control how much phosphorus they eat by making diet recommendations, but the diets are not very palatable for many patients. And commercial production of food includes adding a lot of phosphates that are highly absorbable and not apparent if you just look at the food. It looks like, OK, this food shouldn’t have that much phosphorus in it. But if it has these phosphate salts, you're going to be getting a lot more phosphate than you even know about. There’s even phosphorus included in some medications we give. For instance, certain antidepressants and antihypertensive drugs have phosphate added to the pill, presumably to stabilize the pill in some way. But that’s added phosphorus to the patient.

And then the third barrier is we treat it with phosphate binders. They have to take these with their meals. They have GI side effects. They’re not very potent, so the average patient is taking about 8 to 12 of these pills a day for good phosphorus control. And if they skip days, they obviously don’t have good control.