Hyperphosphatemia is a strong predictor of mortality in advanced CKD and is remediated via diet,
phosphorus binders, and dialysis. Dietary counseling should encourage the consumption of foods with the least amount of inorganic or absorbable
phosphorus, low
phosphorus-to-
protein ratios, and adequate
protein content, and discourage excessive
calcium intake in high-risk patients. Emerging educational initiatives include food labeling using a "traffic light" scheme, motivational interviewing techniques, and the
Phosphate Education Program - whereby patients no longer have to memorize the
phosphorus content of each individual food component, but only a "
phosphorus unit" value for a limited number of food groups.
Phosphorus binders are associated with a clear survival advantage in CKD patients, overcome the limitations associated with
dietary phosphorus restriction, and permit a more flexible approach to achieving normalization of
phosphorus levels.
CONCLUSION: