Monitoring in Phosphate Binder Therapy

Calcium Carbonate

• are well tolerated and a cost effective first line treatment option for hyperphosphatemia. 
• Using principally calcium‐containing phosphate binders increases the risk of positive calcium balance especially if concomitant use of vitamin D increasing the risk of vascular calcification and arterial disease. 
• Serum calcium should be maintained within normal ranges to avoid hypercalcaemia

Monitoring

• No specific recommendation for monitoring parameters
• Recommended titration is 1-6 monthly based on Calcium and Phosphate levels

Disease

• Monitoring depends on conditions and indications.
• For example, hypercalcaemia and hypocalcaemia may changes in ECG (QT interval), which may necessitates more frequent monitoring
• Calcium salts may also enhance the arrythmogenic effects of digoxin

Animal Study

• Based on animal studies, level of phosphate is shown to drop significantly even at a period of 2 weeks. Drop is seen consistent over a period of 10 weeks.

Routine Monitoring

• Phosphate level monitoring is routinely conducted in patients with CKD
• This depends on the severity and disease level

References:

1. http://emedicine.medscape.com/article/241185-workup
2. http://www2.kidney.org/professionals/KDOQI/guidelines_pedbone/guide6.htm
3. http://ndt.oxfordjournals.org/content/19/suppl_1/i19.full
4. http://www.nursing.health.wa.gov.au/docs/career/np/SMAHS/AKDH_Management_Hyperphosphataemia