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| Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: Recommendations for a change in management |
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| Author(s): Block GA, Port FK |
| Source: AMERICAN JOURNAL OF KIDNEY DISEASES Volume: 35 Issue: 6 Pages: 1226-1237 Published: JUN 2000 |
| Times Cited: 325 References: 88 |
| Abstract: Hyperphosphatemia is a predictable consequence of chronic renal failure and is present in most patients on dialysis. Traditionally, the risk associated with elevated serum phosphorus has focused on its impact on renal osteodystrophy. A growing body of evidence, however, suggests that abnormalities in serum phosphorus, calcium-phosphorus product (CaxP), and parathyroid hormone (PTH) levels are resulting in vascular and visceral calcification, thereby contributing to the substantially increased risk of cardiovascular death in this population. In this analysis, we review in detail the literature that describes these associations. We show that the current treatment paradigm for serum phosphorus and secondary hyperparathyroidism is ineffective for a large segment of dialysis patients. Currently, 60% of hemodialysis patients have phosphorus greater than 5.5 mg/dL, and 40% have CaxP greater than 60 mg(2)/dL(2). It is our belief that prevention of uremic calcification, cardiac death, and vascular disease should assume primary importance when evaluating the risks associated with elevated levels of phosphorus, CaxP, and PTH. We recommend that target levels should become 9.2 to 9.6 mg/dL for calcium, 2.5 to 5.5 mg/dL for phosphorus, less than 55 mg(2)/dL(2) for CaxP product, and 100 to 200 pg/mL for intact PTH, (C) 2000 by the National Kidney Foundation, Inc. |
| Document Type: Article |
| Language: English |
| Reprint Address: Block, GA (reprint author), Denver Nephrologists PC, 1601 E 19th Ave,Suite 4300, Denver, CO 80218 USA |
Addresses:
1. Denver Nephrologists PC, Denver, CO 80218 USA
2. Univ Michigan, Dept Internal Med, Div Nephrol, Ann Arbor, MI 48109 USA |
| Publisher: W B SAUNDERS CO, INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA |
| Subject Category: Urology & Nephrology |
| IDS Number: 323HB |
| ISSN: 0272-6386 |
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