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Phosphorus and PTH Goals

Provided by DaVita® Dietitians

Maintaining phosphorus and parathyroid hormone (PTH) in safe ranges is important for all dialysis patients. One of the reasons why an increase in PTH is common with kidney failure is because as blood phosphorus levels rise, so do PTH levels. That’s why it’s vital for dialysis patients to have regular blood tests to monitor these two lab values. Diet, adequate dialysis treatments and medications all play important roles in managing phosphorus and PTH.

Phosphorus goal: 3.0 to 5.5

Phosphorus is a mineral found in many foods, but is especially high in dairy products, beans, whole grains, starchy vegetables, chocolate and cola. Strong bones and teeth depend upon phosphorus. It also helps convert food into energy and stabilize the body’s metabolism. Healthy kidneys release extra phosphorus into the urine; however, kidney disease can prevent the body from getting rid of the excess. High amounts of phosphorus cause problems with the bones and heart. Maintaining a phosphorus goal between 3.0 and 5.5 is ideal for dialysis patients. If phosphorus is too high, patients can experience the following:

• Calcium-phosphorus deposits
  • in heart (early heart attack)

  • in skin, lungs and other organs

  • in blood vessels, including those used for dialysis access and those needed for a transplant
• Bone disease
• Red eyes
• Itching
• Increased risk of death

PTH (parathyroid hormone) goal for dialysis patients: 150 to 600*

PTH is made by the parathyroid glands. These are small glands located behind the thyroid gland in the neck. The parathyroid glands regulate calcium and phosphorus levels in the blood. If the blood calcium becomes low, the parathyroid gland will respond by producing more PTH. PTH will pull calcium from the bones to correct the low blood calcium level. If dialysis patients don’t keep PTH levels in the safe range of 150 to 600, they risk the following:

• Bone disease
  • bone and joint pain
  • weak and brittle bones
  • broken bones
• Loss of independence
• Increased risk of death

*PTH goal may vary for some individuals. Normal PTH for a person without kidney disease is 10-65 pg/mL.

Preventing high phosphorus and PTH levels

Taking an active role in your healthcare is important in maintaining healthy phosphorus and PTH levels in your blood. Knowing lab results, consulting with a doctor regularly and following a low-phosphorus diet can help. Here are some preventive measures to help you reach phosphorus and PTH goals:

• Receive adequate dialysis by dialyzing for your full treatment, every time.
• Avoid high-phosphorus foods.
• Take phosphate binders with every meal.
• Take phosphate binders with every snack, if prescribed.
• If Sensipar^® (cinacalcet) — a drug prescribed to treat hyperparathyroidism, a condition that leads the body to produce too much PTH — is prescribed, take as directed.

Summary

Maintaining the proper phosphorus and PTH levels is crucial for people with CKD and those on dialysis. Being proactive, knowing what your phosphorus and PTH levels are, following your prescribed treatments and avoiding food high in phosphorus can help overall health.

Related articles on DaVita.com

• Overview of PTH
• Phosphorus and Chronic Kidney Disease
• Potassium, Phosphorus and the Dialysis Diet