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P is a key ion in the body, with important diverse functions. The maintenance of serum P levels is dependent on normal kidney function. As a result, patients with kidney disease are often hyperphosphatemic. Elevations in serum P are associated with increased morbidity and mortality in patients with CKD, may hasten loss of residual renal function, and can cause secondary hyperparathyroidism. Unfortunately, current removal of P with thrice weekly hemodialysis or daily peritoneal dialysis is not adequate for normal dietary intake. As a result, phosphate binders are a mainstay of therapy in patients with CKD.

P is a key ion in the body, with important diverse functions. The maintenance of serum P levels is dependent on normal kidney function. As a result, patients with kidney disease are often hyperphosphatemic. Elevations in serum P are associated with increased morbidity and mortality in patients with CKD, may hasten loss of residual renal function, and can cause secondary hyperparathyroidism. Unfortunately, current removal of P with thrice weekly hemodialysis or daily peritoneal dialysis is not adequate for normal dietary intake. As a result, phosphate binders are a mainstay of therapy in patients with CKD.

Secondary hyperparathyroidism is a universal complication in patients with CKD and occurs early in the development of renal failure. As GFR declines, reduction in serum calcitriol levels, moderate decreases in ionized calcium, and reduced excretion of serum phosphorus contribute to the development of SHPT. Traditional approaches in the treatment of SHPT have focused on phosphorus control, through dietary phosphate restriction, calcium and non-calcium-based phosphate binders, and vitamin D sterols. In cases of severe hyperaparathy-roidism resistant to traditional therapies, parathyroidectomy was the treatment of choice. However, now with the introduction of the calcimimetic agent cinacalcet, additional medical therapy is available as an alternative to surgery. The importance of controlling PTH, serum phosphorus, and calcium goes beyond treatment of bone disease and may have a significant impact on other organ systems and ultimately cardiovascular morbidity and mortality. Prospective, randomized trials to test the value of vitamin D therapies and calcimimetics in reducing cardiovascular and all-cause mortality need to be pursued.

P is a key ion in the body, with important diverse functions. The maintenance of serum P levels is dependent on normal kidney function. As a result, patients with kidney disease are often hyperphosphatemic. Elevations in serum P are associated with increased morbidity and mortality in patients with CKD, may hasten loss of residual renal function, and can cause secondary hyperparathyroidism. Unfortunately, current removal of P with thrice weekly hemodialysis or daily peritoneal dialysis is not adequate for normal dietary intake. As a result, phosphate binders are a mainstay of therapy in patients with CKD.

P is a key ion in the body, with important diverse functions. The maintenance of serum P levels is dependent on normal kidney function. As a result, patients with kidney disease are often hyperphosphatemic. Elevations in serum P are associated with increased morbidity and mortality in patients with CKD, may hasten loss of residual renal function, and can cause secondary hyperparathyroidism. Unfortunately, current removal of P with thrice weekly hemodialysis or daily peritoneal dialysis is not adequate for normal dietary intake. As a result, phosphate binders are a mainstay of therapy in patients with CKD.

P is a key ion in the body, with important diverse functions. The maintenance of serum P levels is dependent on normal kidney function. As a result, patients with kidney disease are often hyperphosphatemic. Elevations in serum P are associated with increased morbidity and mortality in patients with CKD, may hasten loss of residual renal function, and can cause secondary hyperparathyroidism. Unfortunately, current removal of P with thrice weekly hemodialysis or daily peritoneal dialysis is not adequate for normal dietary intake. As a result, phosphate binders are a mainstay of therapy in patients with CKD.

P is a key ion in the body, with important diverse functions. The maintenance of serum P levels is dependent on normal kidney function. As a result, patients with kidney disease are often hyperphosphatemic. Elevations in serum P are associated with increased morbidity and mortality in patients with CKD, may hasten loss of residual renal function, and can cause secondary hyperparathyroidism. Unfortunately, current removal of P with thrice weekly hemodialysis or daily peritoneal dialysis is not adequate for normal dietary intake. As a result, phosphate binders are a mainstay of therapy in patients with CKD.