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ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

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Kidney Week

Educational Symposium

Phosphorus Control in Hemodialysis: What's the Optimal Strategy?

October 22, 2020 | 01:00 PM - 02:00 PM

Location: Simulive

Session Description

Phosphorus is an essential mineral that is abundant in many dietary sources. CKD can substantially alter phosphorus homeostasis, leading to increased serum phosphate levels due to decreased renal clearance. Conventional dialysis typically removes only 500-800 mg of phosphorus per session, lower than the average daily intake. Hyperphosphatemia has been associated with multiple adverse outcomes, including increased vascular calcification, major adverse cardiovascular events, and mortality. Very little clinical trial evidence provides guidance on the optimal level of phosphate.

Maintaining phosphate levels within the normal range may prevent adverse events from occurring. However, controlling phosphorus by dietary restriction may carry distinct risks. Because phosphorus is found in many food sources, particularly proteins, dietary restriction of phosphorus may inadvertently lead to malnutrition. Phosphorus binders are available but typically represent a significant pill burden, which may also impair appetite. In addition, some binders have been associated with end-organ damage. The ongoing HiLo cluster-randomized pragmatic trial will compare the effects of a higher serum phosphate target (>6.5 mg/dL) with a lower serum phosphate target (<5.5 mg/dL) with respect to all-cause hospitalization and all-cause mortality. The primary hypothesis is that less stringent control of serum phosphate levels will be associated with a lower risk of adverse events.

Support is provided by an educational grant from Fresenius Medical Care Renal Therapies Group.

Learning Objective(s)

  • Describe the evidence linking hyperphosphatemia to adverse outcomes
  • Discuss the pros and cons of strict phosphate control for patients requiring maintenance hemodialysis

Learning Pathway(s)

  • Dialysis
  • Bone and Mineral Metabolism


  • Joachim H. Ix, MD, FASN


  • Introduction
    01:00 PM - 01:10 PM
    Joachim H. Ix, MD, FASN 
  • Relationship Between Hyperphosphatemia and Adverse Outcomes
    01:10 PM - 01:35 PM
    Orlando M. Gutierrez, MD 
  • Pros and Cons of Phosphate Restriction in Patients Requiring Maintenance Dialysis: Balancing Nutritional Status with Phosphate Control
    01:35 PM - 02:00 PM
    Connie Rhee, MD, MS