Hyperphosphatemia

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

Phosphate is a type of electrolyte. Your body needs it for many important functions. It helps form your bones and teeth. It also helps your cells make energy and build cell membranes and DNA. But if you have too much phosphate in your body, it can cause problems.

Among most people throughout the world, hyperphosphatemia (pronounced “hahy-per-FOS-fuh-TEE-mee-uh”) isn’t common. But if you have advanced chronic kidney disease (CKD), it’s common.

What are the symptoms of too much phosphorus?

Hyperphosphatemia usually doesn’t have any immediate symptoms by itself. But it can remove calcium from your bones and blood. This may cause hypocalcemia. Hypocalcemia symptoms include:

• Muscle cramps
• Brittle nails
• Dry skin
• Rougher (coarser) hair than what’s normal for you
• Memory problems
• Mood swings, including irritability
• Tingling in your lips, tongue, fingers and/or feet (paresthesia)
• Seizures
• Abnormal heart rhythms (arrhythmia)

What causes high phosphate levels in the body?

Common hyperphosphatemia causes include:

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

Though not as common, it may also develop due to:

• Diabetes-related ketoacidosis
• Muscle disintegration (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)
• Eating or drinking too much phosphate or receiving too much phosphate in an enema

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

Risk factors

Anyone can get hyperphosphatemia. But you’re more likely to have it if you have advanced chronic kidney disease or kidney failure.

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

• Have diabetes
• Have high blood pressure
• Have heart disease
• Have a biological 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, including over-the-counter products, like nonsteroidal anti-inflammatory drugs (NSAIDs)

What are the complications?

Losing calcium can make your bones brittle. It can also cause calcium deposits in your eyes, lungs, heart and blood vessels. This increases your risk of heart attack, stroke and death.

How doctors diagnose hyperphosphatemia

A healthcare provider will first:

• Look over your medical history
• Ask about your symptoms, eating patterns and any medications you’re currently taking
• Conduct a physical exam

If they suspect hyperphosphatemia, they must conduct a blood test to check your phosphorus levels. A phosphorus level greater than 4.5 milligrams per deciliter (mg/dL) means you have hyperphosphatemia.

If you have hyperphosphatemia, your provider may recommend further testing to check for kidney disease. These tests may include:

• More blood tests
• Urine protein test
• Imaging tests, including an ultrasound, MRI and CT scan
• Kidney biopsy

How do you treat hyperphosphatemia?

Treatment depends on what’s causing phosphate to build up in your blood. Certain foods, drinks and medications can cause your phosphate levels to rise. You may need to cut back on or stop consuming some foods and drinks. You may also need to find different medicines that have lower phosphate levels.

Your provider may also prescribe phosphate binders. These medicines make it harder for your body to absorb phosphate, so more phosphate leaves your body when you use the bathroom.

Your provider may also 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 kidney-healthy diet that limits the amount of phosphate in your body.

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

When should I see my healthcare provider?

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

• Changes to your pee and peeing habits
• Swelling
• Fatigue

During your appointment, you may want to ask your provider:

• What’s a healthy blood phosphate level?
• What medications do you recommend?
• How much phosphate should I consume every day?
• Can you refer me to a renal dietitian?
• Should I see a nephrologist or another specialist?

What can I expect if I have hyperphosphatemia?

It depends on what’s causing your elevated phosphate levels. Your healthcare provider will give you a better idea of what to expect according to the cause.

If hyperphosphatemia develops because of advanced chronic kidney disease, you may need to make some big changes — cutting back on certain foods and drinks, taking medications at specific times and having regular check-ups and dialysis. But with proper diagnosis and treatment, high phosphate levels won’t have as big an impact on your life.