Hyperphosphatemia is a big deal in dialysis management. The main point is: The majority of the dialysis population is there because, during years of their lives (before becoming a dialysis dependent) they were, let me put this way, non-compliant with the baseline diseases that took them into dialysis. At that point, taken Hypertension as an example, controlling BP, proper diet, physical activities, regular medical visits and other steps could, if not prevent, at least postpone the dialysis dependency.

Now they are in dialysis, where the renal function basically does not provide what the body needs to remove the toxins that must be removed. At this level, the compliance becomes more aggressive and some sort of medication kick in a more regular basis. Many of my patients think that “If life style changes never worked before dialysis, why should I have to diet now?, for example.

And that is the exact point where medications as phosphate binders take place. On dialysis, patients have a combination of “life depression mode”, “giving up life”, “non-adherence to things they had difficulty to adhere before” and “improper diet”.

An effective binder could, at least, reduce the burden of a high phosphorous intake and this medication would prevent a huge absorption of this element, which may cause severe sequela of having high phosphate levels in the bloodstream and certain organs or part of them, like heart valves, for example.

I am used to say that phosphorous is a “silent killer”, once we do not see the damage right away, but a chronic hyperphosphatemia will certainly cause irreversible damages in some target organs.

Another interesting point is related to the phosphate buffer system, which helps to regulate pH inside bloodstream. Phosphorous is actually one of the elements that is able to support pH regulation and its excess, besides causing excessive phosphorylation of some organic compounds, may also interfere with this regulation, already compromised by the end stage kidney disease.

I hope you like this new article!