Exposure to gadolinium-based contrast agents should be minimized in patients with advanced CKD.

Iron-based compounds and nicotinic acid derivatives are among a number of agents under investigation.

Hyperphosphatemia is the harbinger of numerous complications in patients with CKD, and these complications become most evident in patients who require dialysis.

Elevated serum phosphate levels are associated with all-cause and cardiovascular mortality in patients on dialysis, as demonstrated in a 2004 study by Block and colleagues (J Am Soc Nephrol. 2004;15:2208-2218).

Hyperphosphatemia is a known risk factor for death in both the general and CKD populations and a correlate of faster CKD progression (Clin J Am Soc Neph. 2006;1:825-831). Moreover, hyperphosphatemia results in additional mineral and bone disorders (MBDs), such as the inhibition of 1a-hydroxylation of 25-hydroxycalciferol via the hyperphosphatemia-induced fibroblast growth factor-23 (FGF-23) pathway.

This article is the second in a series on hyperphosphatemia management in CKD patients.

This article is the first in a series that will discuss various aspects of hyperphosphatemia in patients with renal disease. Csaba P. Kovesdy, MD, chief of nephrology at the Salem VA Medical Center, in Salem, Va., is the series editor.

Protection of renal function is a primary concern of physicians who manage surgical or medical diseases of the kidney, such as renal tumors, urinary calculi, renal vascular disease, or ureteropelvic junction obstruction.