Phosphate metabolism in cases of chronic renal insufficiency : PPPPathophysiology and therapy [Phosphathaushalt bei chronischer niereninsuffizienz : pathophysiologie und therapie]

Hyperphosphatemia is a typical complication of chronic renal disease that contributes to the pathogenesis of secondary hyperparathyroidism and renal osteodystrophy. Recently, an association between phosphate accumulation and cardiovascular morbidity and mortality has also been observed in patients with end stage renal disease. As dietary restriction alone cannot guarantee a neutral phosphate balance, especially when renal disease is advanced, gastrointestinal phosphate binders have been used for decades. During this period aluminium containing agents were replaced by calcium based compounds. Due to the continuous positive calcium balance these drugs have recently been replaced by non aluminium-non calcium containing agents. Phosphate elimination by dialysis can be improved by increased treatment frequency. © Springer-Verlag 2007.