Compliance issues in the Management of Hyperphosphatemia

Abstract

Chronic kidney disease (CKD) is an important problem in public health and has significant morbidity and mortality implications. Mineral and bone disorders are common during CKD and occur in the early stages of the disease. During CKD a progressive reduction of the excretion of many substances, including phosphorus, is reported. The phosphorus balance is altered from the early stages of disease, and its variation has been related both to mineral bone disorders and cardiovascular disease. Of note, phosphate levels, which are frequently high in late stages of CKD, do not represent the total phosphate balance, which is influenced also by dietary phosphate intake, intestinal absorption and renal excretion. Correct phosphate control in CKD patients can be obtained by operating at different levels: 1) optimization of dialysis: type of dialysis (hemodialysis versus peritoneal dialysis), vascular access characteristics, modalities and duration of dialysis; 2) reduction of dietary phosphate intake, obtained by the consumption of low-phosphate food and by educating patients in cooking styles; 3) use of drugs able to reduce intestinal phosphate absorption. For each of these approaches, and to ameliorate patient compliance, it is mandatory to correctly instruct patients, explaining to them specific concepts about hyperphosphatemia and its treatment and about the use of phosphate binders. The aim of this review is to summarize the principal concepts concerning phosphate anomalies during CKD and compliance difficulties in the treatment of hyperphosphatemia.