Hyperphosphatemia Management in Hemodialysis

Abstract

Introduction: Hyperphosphatemia is an independent predictor of mortality in hemodialysis patients. Methods: Systematic review of 28 studies evaluating phosphate binders, dietary restriction, and extended dialysis. Results: Sevelamer reduced serum phosphate by 2 mg/dL and lowered all-cause mortality by 15% compared to calcium acetate. Dietary phosphate education alone achieved only 0.5 mg/dL reduction. Nocturnal hemodialysis (8 hours) normalized phosphate without binders in 60%. Discussion: Non-calcium binders avoid vascular calcification but have higher pill burden. Conclusion: Combined dietary, binder, and extended-hour dialysis strategies are most effective.