[Treatment of hyperphosphatemia in hemodialysis patients].

Hyperphosphatemia plays a key role in the development of hyperparathyroidism and extraosseous calcification and is associated with increased mortality in hemodialysis patients. The treatment of hyperphosphatemia therefore represents a cornerstone in the management of dialyzed patients. NFK-KDOQI 2003 has recommended rigorous control of serum phosphorus to between 1.13-1.78 mmol/l. A multiple-factor approach can be used to reduce serum phosphate: 1) reduce phosphorous intake in the diet; 2) increase phosphate removal by dialytic treatment; 3) use old and new phosphate binders; 4) treat with nicotinamide; and 5) control serum parathyroid hormone levels. All these points are discussed in this review. Recent recommendations for supplemental elemental calcium restriction to 1.5 g per day are reconsidered and indications of new calcium-free phosphate binders are examined.