Hyperphosphatemia: Treatment, Procedure, Cost and Side Effects

Hyperphosphatemia refers to an imbalance of electrolytes leading to large amounts of phosphate in the blood. It can occur due to three main reasons - a huge phosphate load in the body, an increase in the reabsorption of phosphate by the renal system, or insufficient excretion via the kidneys (essentially renal failure). Thus, the treatment of hyperphosphatemia largely depends on addressing the underlying cause of the problem. More often than not, the condition is caused by renal failure as opposed to the other two causes.

One of the ways to treat hyperphosphatemia is to limit the amount of phosphate that’s going into your body. This means that a strict control of the diet is required and dairy products, nuts, meats, high protein foods, and dark colas must be avoided at all costs. The other way to treat hyperphosphatemia is to stimulate renal excretion. Since the body balances out the amount of phosphate in the system through this excretion, the failure of the kidneys leads to this condition developing. Patients usually have to undergo dialysis to stimulate the purification of the body and the outward flow of urine.

Sometimes, large amounts calcium deposits formulate in the body due to hyperphosphatemia. In this case, surgery is required to remove them. Parathyroidectemies are also often conducted in such patients. It does go without saying that the intensity of the treatments largely depends on the individual medical histories of the patients.

To start with, you will have to alter your diet as this supports the treatment for hyperphosphatemia and by controlling the amount of phosphate you consume, you will be eliminating the chances of worsening the condition. Your doctor will recommend the correct diet for you to follow based on your medical history.

Since hyperphosphatemia is often caused by renal failure, the next accompanying step in the treatment is dialysis. There are two types of dialysis treatments – hemodialysis (in which blood is pumped into the machine and purified) and peritoneal dialysis (in which dialysis fluid is inserted into the stomach to excrete waste material. For hemodialysis, a new blood vessel known as the AV fistula is created in your body. Then, two thin needles are inserted into this vessel. The first needle extracts the blood and pumps it into the machine where it is purified and the second needle puts the clean, urine free blood back into your system. Each session lasts nearly 4 hours, however you are able to relax, watch television, read a book, or do what you like to pass the time, as long as you are sitting in one place or lying down. You can even have the procedure at home. For peritoneal dialysis, an opening is made in the abdomen and a catheter is inserted right below the belly button. The catheter will be left there and people often have to learn to live with it during the course of their treatment. First, a bag with the dialysis fluids is attached to the catheter so that it can wash your abdomen, and then a different bag is placed to collect the excretion. The process itself is quite painless. It lasts for 30 minutes.

Any person with hyperphosphatemia caused by renal failure is eligible to be treated with dialysis. People who have hyperphosphatemia that is caused due to their diet are eligible to be treated with a restricted diet.

People who do not have hyperphosphatemia are not eligible to be treated for it.

Hemodialysis comes with its own set of side effects that one should be vary of. The first is fatigue. Patients generally feel exhausted during or right after the dialysis is performed. They can also get low blood pressure as the circulation of the blood is being controlled by the external machine and not just your heart. Furthermore, dialysis can put you at risk for sepsis or blood poisoning, due to which you can get multi organ failure. Muscle cramps and itchy skin are minor side effects that come with the procedure. Loss of sex drive, erectile dysfunction, dry mouth, insomnia, pain in the bones and joints, and anxiety are other side effects to be vary of.

With any kind of dialysis, the treatment goes on until a new kidney is found for the patient. Therefore, the post treatment guidelines apply to each session of dialysis. Patients are generally advised to maintain strict control over their diet. As the dialysis removes liquid worth two or three days of build up, patients are not allowed to drink more than two or three pints of fluids in a day as it can lead to an excess of fluids in the system. Foods that have sodium, potassium, and phosphate are meant to be avoided. Although it is possible to have a successful and normal pregnancy while undergoing dialysis, patients are advised not to get pregnant during this time as it can be risky for the mother and the baby.

Hyperphosphatemia is largely caused due to renal failure. While the amount of phosphate in the body can be controlled and regulated through the diet and through dialysis, a true recovery takes place once the renal failure is addressed. Without addressing it, the phosphate levels in the body will continue to be high. Therefore, the recovery period depends largely on when the renal failure is eliminated, which occurs with a kidney transplant. It can take years to find a viable kidney.

Treating kidney failure can be pretty expensive in India. The average cost for getting hemodialysis can range anywhere between Rs. 10,000 to Rs. 12,000. On the other hand, the average cost for getting peritoneal dialysis can be anywhere between Rs. 18,000 to Rs. 20,000. The average cost for seeing a dietician can range from Rs. 3,000 to Rs. 5,000 per month.

Once kidney failure is addressed, the results for treating hyperphosphatemia are permanent.

While alternative treatments are being explored, none are known to have exceptionally high success rates. Daily nocturnal dialysis is one method that is being explored and is known to decrease the necessity of the phosphate binders in the system.