Hyperphosphatemia

What is hyperphosphatemia?

Hyperphosphatemia is a condition in which you have excess phosphate (phosphorus) in your blood.

Phosphate is a type of electrolyte. Electrolytes are minerals that have a natural positive or negative charge when dissolved in water or other body fluids, such as blood.

Who can develop hyperphosphatemia?

Anybody can get hyperphosphatemia. However, you’re more likely to have hyperphosphatemia if you have advanced chronic kidney disease or kidney failure.

You’re at a greater risk of chronic kidney disease or kidney failure if you:

• Have diabetes.
• Have high blood pressure (hypertension).
• Have heart disease.
• Have a family history of kidney disease.
• Have abnormal kidney structure.
• Are Black, Hispanic, Asian, Native American, First Nations or Alaska Native.
• Are over 60.
• Have a long history of taking pain relievers frequently, including over-the-counter (OTC) products such as nonsteroidal anti-inflammatory drugs (NSAIDs).

How common is hyperphosphatemia?

Among most people throughout the world, hyperphosphatemia alone is rare. However, if you have advanced chronic kidney disease, hyperphosphatemia is common. Approximately 70% of people with advanced chronic kidney disease have hyperphosphatemia.

What happens when phosphate levels are too high?

Your body needs phosphate to help form and strengthen your bones and teeth. It also helps your cells produce energy and build cell membranes.

But if your phosphate levels are too high, it can remove calcium from your bones, which makes them brittle. It can also cause calcium deposits in your eyes, lungs, heart and blood vessels, which increase your risk of heart attack, stroke and death over time.

What are the symptoms of hyperphosphatemia?

Hyperphosphatemia usually doesn’t have any immediate symptoms by itself. However, hyperphosphatemia can remove calcium from your bones and blood, which may cause hypocalcemia.

Hypocalcemia symptoms include:

• Muscle cramps.
• Brittle nails.
• Dry skin.
• Coarser hair than what’s normal for you.
• Memory problems.
• Irritability.
• Tingling in your lips, tongue, fingers and/or feet.
• Seizures.
• Abnormal heart rhythms (arrhythmia).

What causes hyperphosphatemia?

Hyperphosphatemia causes include:

• Advanced chronic kidney disease.
• Hypoparathyroidism.
• Lower-than-normal blood pH (increased acids in the blood) because your lungs can’t remove all of the carbon dioxide your body produces (respiratory acidosis).
• Lower-than-normal blood pH for other reasons (metabolic acidosis).

Though not as common, hyperphosphatemia can also develop as a result of:

• Diabetes-related ketoacidosis.
• Damage to your muscles (rhabdomyolysis).
• Severe infection (sepsis).
• Physical trauma from something heavy falling on you or pressing on you for a long time (crush injury).
• Your body not properly responding to your parathyroid hormone (pseudohypoparathyroidism).
• Consuming too much phosphate in your diet or receiving too much phosphate in an enema.

What is the most common cause of hyperphosphatemia?

Advanced chronic kidney disease is the most common cause of hyperphosphatemia.

Is hyperphosphatemia contagious?

No, hyperphosphatemia isn’t contagious. You can’t spread hyperphosphatemia to another person through any means other than genetics in very rare cases.

How is hyperphosphatemia diagnosed?

A healthcare provider can diagnose hyperphosphatemia. They’ll look over your medical history, conduct a physical examination and ask about your symptoms, diet and any medications you’re currently taking. In order to check the phosphate levels in your blood, they must conduct a blood test.

During a blood test, the provider will use a thin needle (21 gauge, slightly smaller than the size of a standard earring) to withdraw a small amount of blood from a vein in your arm. They’ll send the sample to a laboratory to measure the amount of phosphate in your blood. A phosphate level greater than 4.5 milligrams per deciliter (mg/dL) indicates you have hyperphosphatemia.

If you have hyperphosphatemia, your provider may then order additional tests to check for kidney disease. These tests may include:

• Additional blood tests.
• Urine protein test.
• Ultrasound.
• MRI.
• CT scan.
• Kidney biopsy.

How is hyperphosphatemia treated?

Hyperphosphatemia treatment depends on what’s causing phosphate to build up in your blood. Certain foods, drinks and medications can elevate your phosphate levels. You may need to limit or eliminate some foods and drinks from your diet, or you may need to find alternative medicines that have lower phosphate levels.

Your provider may also prescribe medicines that make phosphate harder for your body to absorb, so more phosphate passes out of your body when you urinate (pee). These medicines include:

• Sevelamer (RenaGel®).
• Lanthanum (Fosrenol®).
• Calcium acetate (Calphron®).

If kidney failure is causing your high phosphate levels, your provider may order dialysis. Dialysis does the work of your kidneys. It removes excess fluid and waste products from your blood, including phosphate.

What foods cause high phosphorus levels?

Foods and drinks that have high levels of phosphorus include:

• Dairy, including milk, processed cheeses and yogurt.
• Soda pop.
• Processed meats.
• Fast food.
• Snack foods.
• Nuts.
• Whole grains, including wheat, oats and rice.
• Beans.
• Lentils.

Your healthcare provider may refer you to a renal (kidney) dietitian. A renal dietitian is a food and nutrition expert who specializes in kidney health. They’ll work with you to develop a special renal diet that limits the amount of phosphate in your body.

How can I prevent hyperphosphatemia?

The best way to prevent hyperphosphatemia is to be aware of your kidney health and to limit the amounts of phosphate and calcium you put in your body. If you’re at risk of hyperphosphatemia, talk to a healthcare provider. They may refer you to a nephrologist. A nephrologist is a doctor who specializes in conditions that affect your kidneys.

When should I see a healthcare provider?

See your healthcare provider right away if you have hyperphosphatemia and develop symptoms of kidney disease or kidney failure.

What questions should I ask a healthcare provider?

• How do you know that I have hyperphosphatemia?
• If I don’t have hyperphosphatemia, what other condition might I have?
• What’s a healthy blood phosphate level?
• What medications do you recommend?
• Do I need a prescription for medications or are they available over the counter?
• What foods and drinks should I avoid?
• How much phosphorus should I eat every day?
• Can you refer me to a renal dietitian?
• Should I see a nephrologist or another specialist?

What is the difference between hyperphosphatemia and hypocalcemia?

Hyperphosphatemia is a condition in which the phosphate levels in your blood are too high.

Hypocalcemia is a condition in which the calcium levels in your blood are too low. Hypocalcemia is usually a side effect of other conditions, including hyperphosphatemia.

A note from Cleveland Clinic

Hyperphosphatemia is a condition in which you have too much phosphate in your blood. It’s not a common condition among most people throughout the world. However, it’s very common if you have advanced chronic kidney disease or kidney failure. It usually doesn’t have symptoms — most people don’t realize they have hyperphosphatemia until it causes another condition with observable symptoms.

You may feel anxious or overwhelmed if you have hyperphosphatemia, especially if you require dialysis to help treat it. These feelings are normal. Talk to your healthcare provider about any concerns or questions you may have. They can answer your questions and provide support and advice on how you can best treat hyperphosphatemia.