What management is required for chronic kidney disease (CKD) with elevated PTH and hyperphosphatemia?

In chronic kidney disease (CKD), the kidneys lose their ability to effectively filter waste products from the blood, which often results in a buildup of phosphates. This condition can lead to hyperphosphatemia, characterized by elevated phosphate levels in the blood. Additionally, as kidney function declines, the synthesis of active vitamin D is impaired, leading to decreased calcium absorption and consequently stimulating the parathyroid glands to secrete more parathyroid hormone (PTH). This can further exacerbate the disturbance in calcium and phosphate metabolism, leading to secondary hyperparathyroidism.

The management strategy involving phosphate binders aims to reduce hyperphosphatemia by preventing phosphate absorption from the diet. Phosphate binders work by chemically binding to phosphate in the gastrointestinal tract, reducing its bioavailability and absorption into the bloodstream. This directly addresses the elevated phosphate levels in patients with CKD. Furthermore, implementing a low phosphate diet complements the use of phosphate binders by minimizing dietary phosphate intake, which is crucial since dietary sources, especially those high in phosphates (like processed foods), can worsen hyperphosphatemia.

Together, using phosphate binders and a low phosphate diet effectively lowers serum phosphate levels, alleviating symptoms associated with CKD and reducing the risk of