What is the recommended action to keep serum phosphate within range for dialysis patients?

• A. Take PO4 binders
• B. Avoid phosphate binders
• C. Increase phosphate intake
• D. Ignore phosphate levels

Answer: (A)

Controlling phosphate in dialysis patients hinges on reducing intestinal absorption of phosphate. Because the kidneys can’t excrete phosphate effectively, most of the phosphate from food remains in the bloodstream unless it’s bound in the gut. Phosphate binders, taken with meals, bind dietary phosphate in the gastrointestinal tract and form an insoluble complex that is excreted in the stool. This reduces the amount of phosphate that enters the blood and helps keep serum phosphate within the target range. Adherence matters: take the binder with every meal to maximize effect, and choose the binder type with a clinician, since calcium-based options can raise calcium levels and non-calcium binders have different considerations. Ignoring phosphate levels, increasing phosphate intake, or skipping binders would allow phosphate to accumulate and worsen bone-mineral disease and vascular calcification.