Phosphorus is not removed by dialysis well. The phosphorus in your body comes from the food you eat and drink. We measure the phosphorus in your blood and the level should be less than 5.5. If your phosphorus is higher than this, you should be very worried about the damage that the phosphorus is doing to your body and working hard to improve it. If your phosphorus is less than 5.5, then you should congratulate yourself and be determined to keep it there.
High phosphorus leads to a higher chance of dying and being hospitalized due to problems with your blood vesicles including heart problems such as heart attacks and strokes. Also high phosphorus increases the chance that you will have broken bones and bone pain. High phosphorus also causes skin to be itchy. These problems are caused by high phosphorus build up over time. So right now, a high phosphorus may not be giving you symptoms but these problems may be developing.
You get phosphorus in the food you eat and in the fluids you drink. In people with good kidneys, the phosphorus eaten is removed in the urine. As a dialysis patient, little or no phosphorus is eliminated by your urine and only part of the phosphorus you eat is removed by dialysis. Only you can improve your phosphorus but your doctor and dietitian can help. Your dietitian can teach you how to avoid foods with lots of phosphorus. Your doctor will order a medication referred to as a phosphate binder. These medications bind phosphorus that you eat and prevent it from being absorbed into your blood. The phosphorus attaches to a phosphate binder then goes into your stools and is eliminated when you have a bowel movement. No one likes taking phosphate binders. They are needed at every meal and possibly with snacks eaten by dialysis patients. Often, several pills are needed. The pills can be hard to swallow and they need to be carried to wherever you eat since they only work well if taken immediately with your meals. If you do not like your binder, ask your doctor if you can try a different type. There are binders that come as pills, chewable tablets, powder to sprinkle on your food and liquid. However, some insurance plans do not allow patients much choice. Another type of medicine we use sometimes use to control phosphorus is niacin or nicotinic acid. This blocks the phosphorus from being absorbed by your intestines.
Sensipar is another medication we use in dialysis patients. It has several good effects. One is to lower the phosphorus. It is a very expensive medication and insurance plans often give patients problems getting this covered. If you are prescribed Sensipar and you cannot get it at all or if the cost to you is too high, please talk to your dietitian, social worker, nurse or doctor. We can help getting it approved by your insurance and there are patient assistance plans to help you pay for it.
Your doctors are available at answer any questions you may have about this.