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Refractory Hyperphosphataemia — ESENeph MCQ

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ModerateHaemodialysisRefractory HyperphosphataemiaESENeph

A 60-year-old man on haemodialysis has persistent hyperphosphataemia despite Sevelamer 1600 mg TDS. His dietary phosphate intake appears compliant. Calcium is 2.1 mmol/L and PTH is 55 pmol/L. What additional strategy should be considered?

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Correct answer: D — Increase haemodialysis session duration or frequency

In dialysis patients with persistent hyperphosphataemia despite maximal binder therapy and dietary adherence, increasing dialysis dose (longer sessions, more frequent sessions, or nocturnal HD) enhances phosphate clearance. Phosphate removal is time-dependent due to slow mobilisation from intracellular and bone compartments. Extended or more frequent HD sessions significantly improve phosphate control. KDOQI and ERA-EDTA guidelines support this approach.

Reference: ERA-EDTA 2019 – Phosphate Management; KDOQI 2015 – HD Adequacy