This protocol applies to patients with chronic kidney disease stage 5 who are currently receiving dialysis and present with elevated serum phosphorus in the absence of hypercalcemia. The absence of hypercalcemia is clinically significant in this population: elevated calcium in CKD stage 5 carries increased cardiovascular risk and directly influences which binder class is appropriate.
Management is centred on phosphate binders. Both calcium-based and non-calcium-based binder options are available for use in stage 5 dialysis patients, and the specific choice among them depends on individual clinical factors. The full structured protocol details the agents, selection criteria, and sequencing — none of which are reproduced here.
The goal is to achieve a serum phosphorus concentration of 3.5 – 5.5 mg/dL.