For every Mario there is a Luigi- the less well-known but just as important character who never quite gets the appreciation they deserve. The same is true in our bodies. All of us know just how important calcium is for bones, teeth and muscular contraction. Let’s talk about Hyperphosphatemia.

However, phosphate, which is just as important often gets overlooked. It is also integral in lipid membranes, DNA, RNA and thousands of reactions in our body. 

When phosphate levels rise too much, however, there can be serious health consequences. Research shows that 12% of hospital patients suffer from hyperphosphatemia. In patients with End-Stage Renal Disease(ESRD), that number shoots up to 74%. Let’s find out more about this condition and how we can recognise, treat and prevent it. 

What is Hyperphosphatemia?

Hyperphosphatemia refers to elevated serum levels of phosphate in the blood. For reference, the normal plasma inorganic phosphate (Pi )concentration in an adult is 2.5 to 4.5 mg/dl, and men have a slightly higher concentration than women. In children, the normal range is 4 to 7 mg/dl. So levels above 4.5 mg/dl are classified to Hyperphosphatemia.

What causes Hyperphosphatemia?

We take in around 1000 mg of phosphate every day through our diet. 90% of this is excreted daily through the kidneys. From the above facts, it follows that an impairment in renal function or an increase in phosphate intake will lead to disease. Unsurprisingly, these are the major causes of the condition.  

• Chronic Kidney disease – This  is by far the single most important factor behind hyperphosphatemia. Impaired renal function means that the kidneys cannot effectively clear the dietary phosphate load, leading to an accumulation of phosphate in the plasma.
• Hypoparathyroidism – This is  the decreased activity of the parathyroid glands in the body which eventually leads to levels of phosphate.

• Excess phosphate in the diet– This can also precipitate levels of phosphate, especially in those with impaired kidney function. Foods that are high in phosphorus include dairy and dairy products, red meats, processed foods such as fast food and sodas, nuts, beans, lentils etc.

• Uncontrolled Diabetes- leading to diabetic ketoacidosis

• Severe Injuries- Especially crushing injuries that cause muscle damage
  

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• Excessive Vitamin D supplementation  

What are the symptoms of Hyperphosphatemia?

The striking aspect of its symptoms is that it doesn’t produce any symptoms on its own. The symptoms, if any, of hyperphosphatemia are seen mainly due to underlying causes such as chronic kidney disease that leads to hypocalcemia. This manifests as follows-

• Muscle cramps and spasms
• Coarse and brittle nails and hair
• Numbness and a tingling sensation around your lips and extremities
• Bone weakness and pain
• Irregular beating of the heart
• Irritability
• Memory loss and headaches
• Seizures

How is Hyperphosphatemia diagnosed?

Given the scarcity of clinical manifestations, a blood essay is also needed to diagnose hyperphosphatemia. In fact, your clinician may require you to have several blood tests as phosphate levels can vary quite drastically over the course of a day.

Plasma phosphate levels above 4.5 mg/dl lead to a diagnosis of hyperphosphatemia.

Your doctor may also ask for other tests such as urine protein tests, hormone levels, especially PTH, X-rays and CT scans. 

How is Hyperphosphatemia treated?

Treatment for this should be started as soon as possible after a positive diagnosis. The steps involved in the treatment are

• Reduction in the amount of phosphate intake by avoiding foods such as dairy and dairy products, red meats, processed foods such as fast food and sodas, nuts, beans, lentils etc
• Medications such as sevelamer, lanthanum and calcium acetate that prevent excess binding of phosphorus and encourage excretion.
• In cases of renal disorder, the underlying kidney disease must be treated as soon as possible. In severe cases, dialysis may be needed to help the kidneys to deal with the phosphate load
• Treatment for any hormonal upheavals

Takeaway

Despite its lack of symptoms, hyperphosphatemia can be a life-threatening condition. It can also be a signpost for other, more serious systemic ailments and increase your chances of contracting other diseases. It is best treated promptly to prevent further complications.

Hyperphosphatemia Related FAQs

Here are the answers to some frequently asked questions