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Hyperphosphataemia — ESENeph MCQ

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EasyHaemodialysisHyperphosphataemiaESENeph

A 58-year-old man on haemodialysis has a serum phosphate persistently above 1.8 mmol/L despite dietary counselling and Sevelamer 800 mg TDS with meals. Calcium is 2.35 mmol/L and PTH is 42 pmol/L. What is the most appropriate next step?

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Correct answer: D — Increase Sevelamer dose to 1600 mg TDS

The patient has hyperphosphataemia despite current binder therapy and dietary counselling. The first step is to optimise the current binder dose. Sevelamer can be increased to 1600 mg TDS (or even higher). Adding or switching to a calcium-based binder is less appropriate given the patient's calcium is already in the upper normal range. KDIGO CKD-MBD 2017 update suggests restricting calcium-based binders in this context. Lanthanum is an option if Sevelamer is maximised.

Reference: KDIGO 2017 – CKD-MBD Guideline Update