Do you have high phosphate levels in your body? Let's talk about hyperphosphatemia!

Have you ever wondered why sometimes certain things in our bodies are higher than they should be? Maybe a doctor has told you that you have too much phosphate in your blood. Or maybe you have heard about it somewhere. This is what we call hyperphosphatemia. Although the name may sound a bit strange, if we understand it correctly, it is nothing to worry about.

What exactly is hyperphosphatemia?

Simply put, hyperphosphatemia is when your blood has too much of a mineral called phosphate. Phosphate is an essential nutrient for our bodies. It helps keep our bones and teeth strong, provides energy for our cells, and helps make cell membranes.

Think of it this way, phosphate is like a little battery in our body. In order for these to work properly, they need to have an electric charge. Phosphate is one such electrolyte . Electrolytes are minerals that can take on either a positive (+) or negative (-) electrical charge when dissolved in water or a liquid like our blood. So, keeping this phosphate level balanced is important for many functions in the body. Do you understand?

Who is more likely to develop this condition?

Actually, anyone can develop this condition called hyperphosphatemia. However, it is more common in people with kidney problems. Specifically, people with chronic kidney disease (CKD) , especially those with advanced disease, or those with kidney failure, are more likely to develop this condition.

Now, there are factors that can contribute to kidney disease. If you have one or more of the following, you are at a slight risk of developing kidney disease and, through it, hyperphosphatemia:

• If you have diabetes (Diabetes Mellitus) .
• If you have high blood pressure (hypertension) .
• If you have heart disease .
• If someone in your family has had kidney disease (meaning it could be hereditary).
• If there is any abnormality in the structure of your kidneys.
• If you are of African American, Hispanic, Asian, or Native American descent (people in these ethnic groups are more likely to develop kidney disease).
• If you are over 60 years old .
• If you have been a frequent user of pain relievers for a long time , especially nonsteroidal anti-inflammatory drugs (NSAIDs), which can be purchased over the counter at the pharmacy.

How common is this condition?

If you look at the majority of people in the world, it's very rare to have hyperphosphatemia alone. That means just an increase in phosphate in the blood. But, as I said before, if you have chronic kidney disease , especially if it's severe, this condition is very common. Roughly speaking, about 70% of people with severe chronic kidney disease have been found to have hyperphosphatemia.

What happens to the body when phosphate levels increase?

We talked earlier about how phosphate helps strengthen our bones and teeth, provides energy for cells, and helps build cell membranes. That's true. But, like anything, too much of it can cause problems.

Imagine, if the phosphate level in your blood gets too high, it starts to leach calcium from your bones. What happens then? The bones become weak and brittle.

Not only that, but this excess phosphate can cause calcium deposits to form in your eyes, lungs, heart, and blood vessels. This is a bit dangerous. Because over time, these deposits increase your risk of heart attacks, strokes , and even death.

What are the symptoms of Hyperphosphatemia?

Most of the time, when you have only hyperphosphatemia, you don't see any major symptoms. That means you may not realize at first that you have too much phosphate in your body. However, as we've discussed, when this phosphate increases, it can cause calcium to be lost from your bones and blood. That's called hypocalcemia . That means a decrease in the level of calcium in the blood.

So, most of the time, the symptoms of hyperphosphatemia are the same as those caused by hypocalcemia. See if these sound familiar to you:

• Muscle cramps.
• Brittle nails.
• Dry skin.
• Coarser hair than your normal hair.
• Memory problems .
• Irritability.
• Tingling in the lips, tongue, fingertips, and/or feet.
• Sometimes it comes like a fit (seizures).
• Abnormalities in the heartbeat, that is, arrhythmia.

Why does hyperphosphatemia occur?

There could be several reasons for this. The main ones are:

• Advanced chronic kidney disease. This is the most common cause. When the kidneys are not working properly, they are unable to excrete excess phosphate from the body.
• Hypoparathyroidism. This is a condition in which the parathyroid glands produce too little parathyroid hormone, which controls the body's calcium and phosphate levels.
• Your blood pH is lower than normal (meaning your blood is more acidic). This may be because your lungs are unable to get rid of all the carbon dioxide that is produced in your body. This is called respiratory acidosis .
• A decrease in blood pH due to other causes ( metabolic acidosis ).

In addition to these, although less common, hyperphosphatemia can also occur due to the following causes:

• Diabetes-related ketoacidosis.
• Muscle damage ( rhabdomyolysis ).
• Severe infection ( sepsis ).
• Crush injury (injuries caused by something heavy falling on the body or by something pressing on the body for a long time).
• Your body doesn't respond properly to parathyroid hormone ( pseudohypoparathyroidism ).
• Getting too much phosphate into your body, either from the food you eat or through an enema .

What is the most common cause?

As I mentioned before, the main and most common cause of hyperphosphatemia is advanced chronic kidney disease.

Is this a contagious disease?

No, hyperphosphatemia is not a contagious disease. You cannot spread it to others. However, very rarely, it can run in families due to genetic reasons.

How do doctors detect this?

A doctor can tell if you have hyperphosphatemia. He or she will take your medical history , do a physical examination , and ask about your symptoms, your diet, and any medications you take. To find out exactly what your phosphate levels are, you will need to have a blood test .

During a blood test, a doctor or nurse will take a small amount of blood from a vein in your arm using a small needle (21 gauge, a little smaller than the tip of a regular earring). This blood sample is sent to a lab to check how much phosphate is in your blood. If your phosphate level is greater than 4.5 milligrams per deciliter (4.5 mg/dL) , you have hyperphosphatemia.

If you are diagnosed with this condition, your doctor may order additional tests to check the condition of your kidneys. These may include:

• Additional blood tests.
• A test to check for protein in the urine.
• An ultrasound scan.
• An MRI scan.
• CT scan.
• Kidney biopsy ( taking a small piece of kidney tissue for examination).

What are the treatments for this?

Treatment for hyperphosphatemia depends on what is causing the phosphate build-up in your blood. Some foods and medications can also cause high phosphate levels. If this happens, you may need to limit or stop eating certain foods or medications altogether. Or, you may need to switch to a different medication that has lower phosphate levels.

The most important thing is to follow the doctor's instructions exactly.

Your doctor may prescribe medications that reduce the amount of phosphate your body absorbs. This means that more phosphate is excreted in your urine (pee). These medications include:

• Sevelamer (Sevelamer - RenaGel®)
• Lanthanum (Lanthanum - Fosrenol®)
• Calcium acetate (Calcium acetate - Calphron®)

If your phosphate levels are high due to kidney failure, your doctor may start you on dialysis . Dialysis does what your kidneys are supposed to do. That is, it removes excess fluid and waste products, including phosphate, from your blood.

What are foods high in phosphorus?

There are several foods and drinks that are high in phosphorus – the element from which phosphate is formed. It's important to be aware of these, especially if you have hyperphosphatemia.

• Dairy and dairy products, such as milk, processed cheeses, and yogurt.
• Some carbonated drinks (soda pop/fizzy drinks).
• Processed meats ( such as sausages and bacon).
• Fast food.
• Snack foods ( packaged items like chips, biscuits).
• Nuts.
• Whole grains , which include wheat, oats, and rice (especially those with bran).
• Beans.
• Lentils.

Your doctor may refer you to a renal dietitian . These are people who specialize in how to manage your diet to support kidney health. They can help you create a special diet plan (renal diet) that limits the amount of phosphate in your body.

Is there a way to escape this situation?

The best way to prevent hyperphosphatemia is to take care of your kidney health and be aware of the amount of phosphate and calcium you are consuming. If you think you may be at risk for this condition, talk to your doctor. He or she may refer you to a nephrologist . A nephrologist is a doctor who specializes in conditions that affect the kidneys.

What are the best times to see a doctor?

If you know you have hyperphosphatemia, and you develop symptoms of kidney disease or kidney failure, see a doctor immediately. Don't delay.

What questions should you ask a doctor?

When you go to see the doctor, it's very important to ask these questions:

• How do you know for sure if I have hyperphosphatemia?
• If I don't have this condition, what other medical conditions could I have?
• What is a healthy blood phosphate level?
• What medications do you recommend for me?
• Do you need a prescription to get that medicine, or can you just buy it at the pharmacy?
• What foods and drinks should I not eat or drink?
• How much phosphorus should I eat per day?
• Can you refer me to a renal dietitian?
• Should I see a nephrologist or another specialist?

What is the difference between Hyperphosphatemia and Hypocalcemia?

These two can be a bit confusing, so let's clarify.

Hyperphosphatemia is when the phosphate level in your blood is too high .

Hypocalcemia is when the calcium level in your blood becomes too low .

Most of the time, this condition called hypocalcemia occurs as a side effect of another medical condition. Hyperphosphatemia is one such cause of hypocalcemia.

Final Take-Home Message

Okay, so we've talked a lot about hyperphosphatemia. Simply put, it's an increase in the level of phosphate in your blood. While it's not very common in most people in the world, it can be very common in people with chronic kidney disease or kidney failure .

Often, there are no specific symptoms at first. Therefore, many people only realize they have the condition after other symptoms appear, perhaps like hypocalcemia.

When you find out you have hyperphosphatemia, especially when you are told you need dialysis, it is normal to feel anxious and scared. There is nothing wrong with having those feelings. Talk to your doctor about any questions or concerns you have. They will answer your questions, give you the support you need, and give you advice on how to best cope with this condition. Remember, you are not alone!

` Hyperphosphatemia, Phosphate, Kidney Disease, Chronic Kidney Disease, Hypocalcemia, Dialysis