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People with kidney disease can work with a renal dietitian and their doctor to keep their phosphorus level in balance. Regular blood tests will show if the phosphorus level in their blood is too high or too low. According to "Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease" by the National Kidney Foundation, patients with kidney disease in stages 3 and 4 should keep their phosphorus between 2.7 and 4.6 mg/dL. Dialysis patients should keep their phosphorus levels in the 3.0 to 5.5 mg/dL range.
Here are seven methods to help control high levels of phosphorus:
1. Reduce the amount of phosphorus you eat
2. Take phosphorus binders
One goal in treating people with end stage renal disease (ESRD) is to prevent phosphorus in the foods they eat from being absorbed into their bloodstream. To help with this, doctors prescribe medicines called phosphorus binders, which are taken with meals and snacks. Binders act as sponges that soak up phosphorus. Instead of going into the bloodstream, phosphorus stays in the stomach and then passes through the gastrointestinal system. A low-phosphorus diet is necessary for phosphorus binders to work well.
3. Take vitamin D
Doctors may prescribe an active form of vitamin D, called calcitriol, to help balance calcium and phosphorus levels. Active vitamin D cannot be taken if calcium or phosphorus levels are too high because it will increase the risk of phosphorus deposits in soft tissues such as arteries, lungs, eyes and skin.
4. Take a calcimimetic medicine
Calcimimetic medication seems to help keep bones healthier in people with kidney disease, lowering parathyroid hormones (PTH), calcium and possibly even phosphorus levels. It's still too early to know, but doctors hope this drug will help people with kidney disease have healthier bones and lower the risk of calcifications and heart problems.
5. Stay on dialysis the entire time
Dialysis treatments remove some phosphorus from the blood. It’s important to stay on dialysis for the full treatment time to achieve optimal results. Between treatments, people on dialysis should be careful to limit how much phosphorus they eat.
6. Start an exercise program approved by a doctor
Exercise can help increase physical strength and, in some cases, even strengthen bones.
7. Get an operation to remove some of the parathyroid glands
In some cases, surgery to remove part of the parathyroid glands may be recommended to prevent long-term release of parathyroid hormones (PTH), leading to weakened bones and calcification of tissues and organs.
Patients should let their doctor and dietitian know all of the medicines and supplements they are taking because some of these may contain phosphorus. All of these efforts can help keep phosphorus in a healthy range.
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