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Hyperphosphatemia: Symptoms, Causes, Diagnosis And Treatment

When there is too much phosphate in the blood, the condition is known as hyperphosphatemia [1] . The most common cause of this illness is kidney disease. However, there are other conditions as well that might lead to the phosphate levels going out of balance. Slowing kidney damage is the best way to reduce the risk of hyperphosphatemia [2] . Also, seeking treatment at the earliest along with the required dietary changes and medication can prevent complications arising from this condition.

Read on to know more about the causes, symptoms, diagnosis and treatment of hyperphosphatemia.

What Is Hyperphosphatemia?

Phosphate is an electrolyte. This electrically charged substance contains phosphorus, a mineral that occurs naturally in food sources [3] . Phosphorus is essential for one's body as it supports the bones and teeth to develop. It also helps in food turning into energy that the body can use.

The functionality of the kidneys aids in controlling the phosphate levels. However, if the working efficiency of the kidneys is affected, then they might not be able to remove the excess phosphate. This leads to high levels of phosphate in the body [1] . High levels of phosphate can lead to bone and muscle problems [2] . It can also increase your risk of strokes and heart attacks. Moreover, a high level of phosphate is most likely an indication of kidney damage.

Hyperphosphatemia

Symptoms Of Hyperphosphatemia

People with high levels of phosphate ideally do not show any specific symptoms. However, high levels of phosphate cause calcium levels of the blood to drop [4] .

The symptoms of low calcium include the following [5] :

  • Weak bones
  • Muscle cramps
  • Rash
  • Itchy skin
  • Numbness and tingling around the mouth
  • Bone and joint pain
Hyperphosphatemia

Causes Of Hyperphosphatemia

  • Apart from kidney disease being the most common cause of hyperphosphatemia, the following conditions could also be linked to high levels of phosphate in the blood:
  • Hypocalcemia: Indicates low levels of calcium in the blood [6] .
  • Hypoparathyroidism: The body does not produce enough parathyroid hormone [7] .
  • Diabetic ketoacidosis: The body begins to run out of insulin. Harmful ketones build up leading to an abnormal rise in blood sugar levels [8] .
  • Uncontrolled diabetes: Indicates high levels of blood sugar that can lead to organ damage [9] .
Hyperphosphatemia

Blood phosphate levels are also seen to rise abruptly if you receive a phosphorus-containing laxative (for instance, as a preparation for a colonoscopy) [10] .

Also, taking phosphate supplements can lead to hyperphosphatemia [11] . Processed foods have added phosphorus to enhance their preservation. Also, a diet high in protein would contain more phosphorus than what the body would require.

Complications Of Hyperphosphatemia

When calcium combines with phosphate, it leads to low levels of calcium in the blood. Low calcium can increase your risk for [12] :

  • Seizures
  • High parathyroid hormone levels
  • Bone disease (renal osteodystrophy)

Diagnosis Of Hyperphosphatemia

The doctor would begin the examination after getting to know the complete medical history of the patient followed by a physical examination and sometimes might also recommend a phosphate test. The tests usually carried out include the following:

  • A timed urine sample: The patient will need to collect all of their urine over a period of a set time (usually 24 hours) [13] .
  • Measuring phosphate in the blood [14] : The doctor would insert a needle into a vein in the arm and take a small amount of blood as a sample. This will be sent to the laboratory for testing the levels of phosphate in the liquid part of the blood (plasma).
  • X-ray: This is essential if the patient shows signs of mineral and bone disorder [15] . The x-ray is useful in revealing calcium deposits in organs or veins. The x-ray also helps in identifying if there are any changes in the structure of a person's bones.
Hyperphosphatemia

Usually, people who have problems with their kidneys, such as kidney failure, would need to undergo regular monitoring. This is done so that the presence of hyperphosphatemia can be determined during the routine checks,

Treatment Of Hyperphosphatemia

The treatment for this condition depends on the underlying cause. The following treatment approaches could be used [16] :

  • In the case of uncontrolled diabetes, it needs to be brought under control through diet, exercise and insulin.
  • A person with hypoparathyroidism would need to take a supplement. This would aim at bringing down the levels of calcium and phosphate in the blood.
  • When hyperphosphatemia is caused due to a kidney disease. A combination of diet and medication is followed to treat it. The aim is to prevent any further damage to the bones.
Hyperphosphatemia
  • Few doctors prescribe the use of a medication containing calcium, known as a phosphate binder [17] . When taken with a meal, this medication would control the amount of phosphorus that the body would absorb from the food.
  • A person with kidney failure would often need to undergo dialysis to clean the blood of waste products and to remove excess fluid. Kidney dialysis is also able to remove some amount of phosphates from the blood.

The following foods are high in phosphorus and therefore, should be limited by a patient suffering from hyperphosphatemia [18] :

  • Red meat
  • Milk
  • Packaged meats
  • Colas
  • Processed cheeses
  • Additives and preservatives
  • Bread
  • Frozen meals
  • Snack products

It is necessary to maintain a diet of healthy foods that contain a proper balance of protein and phosphorus. These usually include chicken, fish, nuts, beans and eggs.

Apart from diet and dialysis, intake of the following drugs might also help in reducing the amount of phosphate your intestines absorb from foods that you eat [19] :

  • Lanthanum
  • Sevelamer hydrochloride
  • Sevelamer carbonate
  • Calcium-based phosphate binders (calcium carbonate and calcium acetate)

Prevention Of Hyperphosphatemia

The best way to prevent this condition is by controlling the levels of phosphate and calcium in the body. A person with hyperphosphatemia should avoid processed foods as they often contain phosphorus as a preservative.

One should aim at slowing down the kidney disease. Kidneys need to be protected by treating the cause of the kidney damage.

  • High blood pressure can weaken the blood vessels that supply the oxygen-rich blood to the kidneys [20] . Intake of blood pressure medicines can lower the blood pressure and protect the kidneys.
  • Presence of extra fluid in the body can overwhelm the damaged kidneys [21] . Taking a diuretic can help in restoring the correct fluid balance in the body.
View Article References
  1. [1] Hruska, K. A., Mathew, S., Lund, R., Qiu, P., & Pratt, R. (2008). Hyperphosphatemia of chronic kidney disease.Kidney international,74(2), 148–157.
  2. [2] Leaf, D. E., & Wolf, M. (2013). A physiologic-based approach to the evaluation of a patient with hyperphosphatemia.American journal of kidney diseases : the official journal of the National Kidney Foundation,61(2), 330–336.
  3. [3] Hunter T. (2012). Why nature chose phosphate to modify proteins.Philosophical transactions of the Royal Society of London. Series B, Biological sciences,367(1602), 2513–2516.
  4. [4] Moe S. M. (2008). Disorders involving calcium, phosphorus, and magnesium.Primary care,35(2), 215–vi.
  5. [5] Fong, J., & Khan, A. (2012). Hypocalcemia: updates in diagnosis and management for primary care.Canadian family physician Medecin de famille canadien,58(2), 158–162.
  6. [6] Fong, J., & Khan, A. (2012). Hypocalcemia: updates in diagnosis and management for primary care.Canadian family physician,58(2), 158-162.
  7. [7] Shoback, D. (2008). Hypoparathyroidism.New England Journal of Medicine,359(4), 391-403.
  8. [8] Glaser, N., Barnett, P., McCaslin, I., Nelson, D., Trainor, J., Louie, J., ... & Kuppermann, N. (2001). Risk factors for cerebral edema in children with diabetic ketoacidosis.New England Journal of Medicine,344(4), 264-269.
  9. [9] Alberti, K. G. M. M., Emerson, P., Darley, J. H., & Hockaday, T. D. R. (1972). 2, 3-Diphosphoglycerate and tissue oxygenation in uncontrolled diabetes mellitus.The Lancet,300(7774), 391-395.
  10. [10] Escalante, C. P., Weiser, M. A., & Finkel, K. (1997). Hyperphosphatemia associated with phosphorus-containing laxatives in a patient with chronic renal insufficiency.Southern medical journal,90(2), 240-242.
  11. [11] Waibel, P. E., Nahorniak, N. A., Dziuk, H. E., Walser, M. M., & Olson, W. G. (1984). Bioavailability of phosphorus in commercial phosphate supplements for turkeys.Poultry science,63(4), 730-737.
  12. [12] Qunibi, W. Y. (2004). Consequences of hyperphosphatemia in patients with end-stage renal disease (ESRD).Kidney International,66, S8-S12.
  13. [13] Sakuma, M., Morimoto, Y., Suzuki, Y., Suzuki, A., Noda, S., Nishino, K., … Arai, H. (2017). Availability of 24-h urine collection method on dietary phosphorus intake estimation.Journal of clinical biochemistry and nutrition,60(2), 125–129. doi:10.3164/jcbn.16-50
  14. [14] Huang, C. X., Plantinga, L. C., Fink, N. E., Melamed, M. L., Coresh, J., & Powe, N. R. (2008). Phosphate levels and blood pressure in incident hemodialysis patients: a longitudinal study.Advances in chronic kidney disease,15(3), 321–331.
  15. [15] Zhou, C., Wang, F., Wang, J. W., Zhang, L. X., & Zhao, M. H. (2016). Mineral and Bone Disorder and Its Association with Cardiovascular Parameters in Chinese Patients with Chronic Kidney Disease.Chinese medical journal,129(19), 2275–2280.
  16. [16] Shaman, A. M., & Kowalski, S. R. (2016). Hyperphosphatemia Management in Patients with Chronic Kidney Disease.Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society,24(4), 494–505.
  17. [17] Schucker, J. J., & Ward, K. E. (2005). Hyperphosphatemia and phosphate binders.American journal of health-system pharmacy,62(22), 2355-2361.
  18. [18] Fouque, D., Casal, M. C., Lindley, E., Rogers, S., Pancířová, J., Kernc, J., & Copley, J. B. (2014). Dietary trends and management of hyperphosphatemia among patients with chronic kidney disease: an international survey of renal care professionals.Journal of Renal Nutrition,24(2), 110-115.
  19. [19] Ketteler, M., Liangos, O., & Biggar, P. H. (2016). Treating hyperphosphatemia–current and advancing drugs.Expert opinion on pharmacotherapy,17(14), 1873-1879.
  20. [20] Tedla, F. M., Brar, A., Browne, R., & Brown, C. (). Hypertension in chronic kidney disease: navigating the evidence.International journal of hypertension,2011, 132405.
  21. [21] Wu, L. W., Chen, W. L., Liaw, F. Y., Sun, Y. S., Yang, H. F., Wang, C. C., … Tsao, Y. T. (2016). Association between fluid intake and kidney function, and survival outcomes analysis: a nationwide population-based study.BMJ open,6(5), e010708.

Read more about: kidney phosphate blood
Story first published: Monday, June 10, 2019, 13:30 [IST]
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