Hyperphosphatemia continues to affect a large portion of the dialysis population and is associated with increased patient mortality, secondary hyperparathyroidism, renal osteodystrophy (ROD), and therapeutic failure of calcitriol. Elevated serum phosphorus is implicated in the pathogenesis of ROD through its effects on calcium and calcitriol levels, PTH production, and parathyroid cell proliferation. The exact role of phosphorus in ROD is not completely defined, however, and clinical management of ROD is complicated by interactions between phosphorus, calcium, PTH, and calcitriol. Despite these challenges, strategies for managing ROD-including early control of serum phosphorus and PTH by low phosphate diet, establishment of markers for optimal parathyroid and bone health, and availability of new therapeutic tools-can help prevent complications and improve patient outcomes
