Dietary Phosphorus Restriction for Control of PTH in CKD Guideline 4.1. Restriction of Dietary Phosphorus in Patients with CKD  Dietary phosphorus should be restricted to mg/day when the serum phosphorus levels are elevated (>4.6 mg/dL [1.49 mmol/L] at stages 3 and 4 of CKD. Commentary  “The available data and the opinion of the Work Group support the proposal that dietary phosphate restriction should be initiated when blood PTH levels begin to rise (Stage 2) and/or when serum phosphorus levels are elevated at any stage of CKD.” Adapted from National Kidney Foundation. Am J Kidney Dis 2003;42(4 suppl 3):S2-S201.

Risk of Death by Quarterly Varying Phosphorus

SPD Study: Change from Baseline in Serum Phosphorus

Calciphylaxis: Case Study Patient: 64-year-old man with a history of cryptogenic cirrhosis. On admission the patient had:  Worsening liver failure  Hypotension  Renal failure Laboratory results: BUN:106 mg/dL (37.8 mmol/L) Creatinine:3.1 mg/dL (274.0 mmol/L) Total calcium:6.7 mg/dL (1.67 mmol/L) Phosphorus4.8 mg/dL (1.55 mmol/L) Calcium x phosphorous product32.2 mg 2 /dL 2 (2.58 mmol 2 /L 2 ) Albumin:1.3 g/dL (13 g/L) Blood, urine, and peritoneal fluid cultures were negative