Offer calcium-based phosphate binders to manage hyperphosphataemia, says NICE

Adults with hyperphosphataemia in chronic kidney disease should be offered a calcium-based phosphate binder as a first-line treatment in addition to dietary management, says NICE.

Increased serum phosphate level in the blood, or hyperphosphataemia, is a comorbidity associated with people who have chronic kidney disease (CKD).

This can lead to the development of secondary hyperparathyroidism, which when left untreated, increases morbidity and mortality, and lead to conditions such as renal bone disease.

There is currently wide variation in the way hyperphosphataemia is treated in the UK. Data from the UK Renal Registry shows that only around 61 per cent of patients receiving haemodialysis, and 70 per cent of patients receiving peritoneal dialysis, are achieving serum phosphate levels within the recommended range.

Latest guidance from NICE on hyperphosphataemia in chronic kidney disease aims to reduce the current variation in care by providing GPs with advice for treating those with the condition.

NICE says that GPs should offer adults calcium acetate as a first-line phosphate binder to control serum phosphate.

This should be in addition to dietary management, which should be carried out by a renal dietitian and supported by healthcare professionals with the necessary skills and competencies.

Dietary management should include dietary assessment, as well as individualised information and advice on dietary phosphate management.

For children and young people, GPs should offer a calcium-based phosphate binder as a first-line phosphate binder in addition to dietary management.

For all patients, at every routine clinical review, the patient's serum phosphate control should be reviewed, taking into account several factors.

These include dietary phosphate management, phosphate binder regimen, adherence to diet and medication, and other factors that influence phosphate control, such as vitamin D or dialysis.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "This is the first guideline produced by NICE for this very specific condition and it should help healthcare professionals to provide the best level of care to aid the treatment of chronic kidney disease.

He added: "This guideline has been produced to ensure all patients with hyperphosphataemia receive the best care possible. It has been produced in the face of varying standards of practice and the type of treatments people with the condition receive, together with a steady rise in the number of people with CKD."

Dr Indranil Dasgupta, Consultant nephrologist at Heartlands Hospital in Birmingham and member of the Guideline Development Group, added: "High blood phosphate level is a common complication of chronic kidney disease and is associated with increased death rate.

"The UK Renal Registry data show that a significant number of dialysis patients do not achieve the target blood phosphate level, and this is believed to be due to wide variation in practice across the UK.

"The NICE guideline will hopefully improve treatment of elevated phosphate level in chronic kidney disease and patient outcome."

A range of implementation tools have been produced to help support the use of this guideline.

These include a costing report, a costing template, and clinical case scenarios and a slide set, which can both be used for training purposes.