The following is a summary of “Serum Phosphorus Level Rises in US Hemodialysis Patients Over the Past Decade: A DOPPS Special Report,” published in the February 2023 issue of  Kidney Medicine by Guedes et al.

Chronic kidney disease often leads to mineral bone disorder (MBD), especially in those with kidney failure who require kidney replacement therapy. Interventions exist to keep blood phosphate and parathyroid hormone levels in check. However, there still needs to be more consensus on the best ways to do so, resulting in differences in practice patterns among countries. Using data from the United States, Japan, and seven European nations (Belgium, France, Germany, Italy, Spain, Sweden, and the United Kingdom), this Special Report details global trends in Dialysis Outcomes and Practice Patterns Study (DOPPS) for MBD biomarkers and treatments from 2002 to 2021. Mean phosphate levels dropped from 5.7 to 5.0 mg/dL in the United States, 5.7 to 5.0 mg/dL in Europe, and 5.6 to 5.2 mg/dL in Japan between 2002 and 2012. 

Since then, average levels have risen in the United States (to 5.6 mg/dL by 2021) while remaining stable in Japan at 5.3 mg/dL and falling in Europe at 4.8 mg/dL. In 2021, the percentage of people whose phosphate levels were >5.5 mg/dL varied considerably among regions. Parathyroid hormone levels increased little while overall phosphate binder use remained steady (80%-84% from 2015-2021) in the United States. The steady rise in serum phosphate in the United States over the past decades may impact patient outcomes, a question that, with any luck, will soon be answered by current clinical trials, even though these results may be the product of widespread knowledge gaps in clinical practice. As new therapies and techniques emerge for managing MBD in chronic renal disease, the DOPPS will continue to monitor them.

Source: sciencedirect.com/science/article/pii/S2590059522002175