What to do if dialysis patients have high phosphorus
In recent years, the number of chronic kidney disease (CKD) and dialysis patients has increased year by year, and hyperphosphatemia has become one of the common complications in dialysis patients. Hyperphosphatemia not only causes secondary hyperparathyroidism, but may also cause serious consequences such as vascular calcification and cardiovascular disease. This article will combine the hot topics and hot content on the Internet in the past 10 days to provide scientific and practical phosphorus reduction solutions for dialysis patients.
1. The dangers of hyperphosphatemia
Hyperphosphatemia is a common metabolic disorder in dialysis patients. Its main hazards include:
| Hazard type | Specific performance |
|---|---|
| cardiovascular disease | Vascular calcification, cardiac hypertrophy, heart failure |
| Bone lesions | Osteoporosis and increased risk of fractures |
| Itchy skin | seriously affect quality of life |
| increased mortality | For every 1 mg/dL increase in serum phosphorus, the risk of death increases by 18% |
2. Reasons for high phosphorus in dialysis patients
The main causes of high phosphorus in dialysis patients include:
| Cause classification | Specific instructions |
|---|---|
| dietary factors | Excessive intake of high-phosphorus foods |
| Insufficient dialysis | Routine hemodialysis has limited phosphorus removal |
| Poor medication compliance | Irregular use of phosphorus binders |
| secondary hyperparathyroidism | Excess secretion of parathyroid hormone leads to bone phosphorus release |
3. Solutions for high phosphorus in dialysis patients
1. Diet control
Dietary control is the basic measure to reduce blood phosphorus. The following is a table of phosphorus content of common foods:
| food category | High phosphorus foods | Low phosphorus alternatives |
|---|---|---|
| dairy products | cheese, yogurt | Rice milk, almond milk |
| meat | Offal, processed meat products | Chicken breast, fish |
| Cereals | Whole wheat bread, oats | white rice, white bread |
| drinks | Coke, beer | Water, light tea |
2. Adequate dialysis
Optimizing the dialysis regimen can improve phosphorus clearance:
| dialysis method | Phosphorus scavenging effect | Suggestions |
|---|---|---|
| routine hemodialysis | 800-1000mg per clearing | 3 times a week, 4 hours each time |
| hemodiafiltration | Cleaning effect increased by 30% | Suitable for refractory hyperphosphatemia |
| Nocturnal dialysis | Best for clearing | 6 times a week, 8 hours each time |
3. Medication
Phosphorus binders are important drugs for controlling blood phosphorus:
| drug type | Representative medicine | Features |
|---|---|---|
| Calcium-phosphate binder | Calcium carbonate, calcium acetate | Low price, may cause hypercalcemia |
| Non-calcium phosphate binder | sevelamer, lanthanum carbonate | Does not cause hypercalcemia and is more expensive |
| Iron-phosphorus binder | ferric citrate | Correct anemia at the same time |
4. Comprehensive management
In addition to the above measures, you also need to pay attention to:
• Regularly monitor serum phosphorus levels with a target value of 3.5-5.5mg/dL
• Control secondary hyperparathyroidism
• Proper exercise can promote the utilization of phosphorus by bones
• Maintain a good psychological state and improve treatment compliance
4. Latest research progress
According to recent research published in medical journals:
| research institute | discover | clinical application value |
|---|---|---|
| Harvard Medical School | Novel phosphate binder Tenapanor reduces intestinal phosphate absorption | Provide new options for stubborn high phosphorus |
| University of Tokyo | Prolonging dialysis time is more effective in reducing phosphorus than increasing dialysis frequency | Support home night dialysis |
| Peking University | Traditional Chinese medicine dietary therapy has achieved preliminary results in assisting phosphorus reduction | Needs further clinical verification |
5. Answers to Frequently Asked Questions by Patients
Q: Why is blood phosphorus still high after strict phosphorus control?
A: Possible reasons include: 1) Incomplete dietary control; 2) Improper use of phosphate binders; 3) Severe secondary hyperparathyroidism; 4) Inadequate dialysis.
Q: Is it harmful if blood phosphorus drops too low?
A: Yes, blood phosphorus lower than 2.5 mg/dL may lead to muscle weakness, bone softening and other problems, and a balance needs to be maintained.
Q: Can I rely solely on drugs to lower phosphorus?
A: No, a three-pronged approach of diet, dialysis and medication is required to effectively control blood phosphorus.
In short, controlling blood phosphate in dialysis patients requires a multi-pronged approach, with personalized plans formulated under the guidance of doctors and regular monitoring, in order to effectively prevent various complications caused by hyperphosphatemia and improve quality of life and survival rate.
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