What Treats High Phosphorus? A Complete Guide to Managing Hyperphosphatemia

December 5, 2025 •

4 min read

Approximately 70% of individuals with advanced chronic kidney disease experience hyperphosphatemia, a condition defined by high phosphorus levels in the blood. Understanding what treats high phosphorus is critical for managing this condition, as uncontrolled levels can contribute to cardiovascular events, bone disease, and other severe health problems. Treatment involves a combination of dietary adjustments, medication, and, in severe cases, dialysis.

Quick Summary

High phosphorus is treated primarily through a combination of dietary restrictions on high-phosphate foods, taking phosphate-binding medications to prevent absorption, and dialysis in cases of end-stage renal disease.

Key Points

High Phosphorus is Dangerous: Uncontrolled hyperphosphatemia, common in chronic kidney disease, can lead to dangerous cardiovascular disease, bone fractures, and soft tissue calcification.
Dietary Restriction is Key: Limiting high-phosphate foods, especially processed items with inorganic phosphate additives, is a primary treatment strategy.
Phosphate Binders Prevent Absorption: Medications called phosphate binders (e.g., calcium-based, non-calcium-based) bind to dietary phosphorus in the gut, preventing its absorption.
Dialysis is for Severe Cases: For end-stage renal disease patients, dialysis removes waste but often requires supplementary binders to fully manage phosphorus.
Newer Medications Exist: Newer treatments like the NHE3 inhibitor Tenapanor offer additional options for patients on dialysis who need better phosphorus control.
Management is a Team Effort: Working closely with a healthcare team, including a dietitian, is essential for a personalized and effective hyperphosphatemia treatment plan.

Understanding Hyperphosphatemia: Why Treatment is Crucial

Phosphorus is a vital mineral that plays a key role in building strong bones and teeth, producing energy, and maintaining cellular health. However, when levels in the blood become too high, a condition known as hyperphosphatemia can develop. The kidneys are responsible for filtering excess phosphorus from the body, so advanced kidney disease is the most common cause of high phosphorus. In the early stages of kidney disease, the body can often compensate, but as kidney function declines, phosphorus begins to accumulate.

The Dangers of Elevated Phosphorus

Chronically high phosphorus levels are more than just a lab abnormality; they pose serious health risks. The excess phosphorus binds with calcium, leading to the formation of calcium phosphate deposits in soft tissues throughout the body. This calcification can affect vital organs, including:

Heart and blood vessels: The hardening of arteries increases the risk of heart attack and stroke, contributing to the high cardiovascular mortality rates seen in kidney disease patients.
Bones: High phosphorus can pull calcium from the bones, making them weak and brittle and increasing the risk of fractures.
Skin: Some patients may experience skin rashes, lumps, and severe itching (pruritus) due to calcium phosphate deposits.

Dietary Management: The First Line of Defense

For many patients, especially those with declining kidney function, managing phosphorus intake through diet is a foundational part of treatment. Restricting high-phosphorus foods is often the first step, and a registered dietitian specializing in kidney health can help create a balanced meal plan.

Reducing Phosphorus Intake

Avoid processed foods: Inorganic phosphate additives, commonly found in processed meats, fast food, convenience meals, and dark sodas, are almost 100% absorbed by the body. It is crucial to read labels and avoid ingredients with "phos" in the name, such as phosphoric acid or sodium phosphate.
Manage organic phosphorus: Organic phosphorus is naturally found in protein-rich foods like meat, poultry, fish, eggs, dairy, nuts, and legumes. The body absorbs less phosphorus from these sources compared to inorganic additives. It is important not to eliminate these foods, as they provide essential protein and nutrients, but to manage portion sizes.
Choose fresh over packaged: Opting for fresh, homemade meals instead of pre-packaged alternatives can significantly reduce your intake of inorganic phosphorus additives.

Pharmacological Treatment: Phosphate Binders

For most dialysis patients and many with advanced CKD, diet alone is insufficient to control phosphorus levels. Phosphate binders are medications taken with meals and snacks that work by binding to dietary phosphorus in the gastrointestinal tract. This forms an insoluble complex that is then eliminated in the feces, preventing the phosphorus from being absorbed into the bloodstream.

Types of Phosphate Binders


Phosphate Binder Class	Common Examples	Advantages	Disadvantages
Calcium-based	Calcium Acetate (PhosLo), Calcium Carbonate (Tums)	Inexpensive, widely available.	Risk of hypercalcemia, which can worsen vascular calcification. May require a high pill burden.
Non-calcium-based	Sevelamer (Renagel, Renvela), Lanthanum Carbonate (Fosrenol)	Does not cause hypercalcemia, may help reduce vascular calcification.	More expensive, can have gastrointestinal side effects, higher pill burden for Sevelamer.
Iron-based	Ferric Citrate (Auryxia), Sucroferric Oxyhydroxide (Velphoro)	May improve iron levels, low pill burden.	Can be costly, may cause diarrhea and discolored stools.
NHE3 Inhibitor	Tenapanor (Xphozah)	New mechanism of action, lowers intestinal phosphate absorption.	Only for adults with CKD on dialysis, approved for use with inadequate response to binders.

Other Medical Approaches

Depending on the cause and severity of hyperphosphatemia, other treatments may be employed:

Calcimimetics: Medications like cinacalcet (Sensipar) can be used to treat secondary hyperparathyroidism, a condition where high phosphorus levels stimulate an overproduction of parathyroid hormone (PTH). These drugs increase the sensitivity of calcium-sensing receptors, helping to regulate PTH and normalize calcium and phosphorus levels.
Addressing underlying causes: For conditions like rhabdomyolysis or tumor lysis syndrome, which can cause an acute spike in phosphorus, treatment focuses on addressing the primary issue. For example, saline diuresis can help flush out excess phosphate.

When Dialysis is Necessary

For patients with end-stage renal disease (ESRD), where the kidneys have largely failed, dialysis is a life-sustaining treatment that helps remove excess phosphorus and other waste products from the blood. Even with dialysis, controlling phosphorus can be challenging. Many dialysis patients still require dietary modifications and phosphate binders to keep their levels in a healthy range, as conventional dialysis often does not remove enough phosphorus on its own. Alternative dialysis schedules, such as more frequent or longer sessions, have been shown to improve phosphorus control.

Conclusion: A Multi-faceted Approach to Treatment

Effectively managing high phosphorus requires a multi-faceted approach centered on collaboration with a healthcare team, including a nephrologist and dietitian. The foundation of treatment involves restricting dietary phosphorus, especially from processed food additives. Phosphate binders are a cornerstone of pharmacological management, with several classes available to suit individual patient needs. For those with advanced kidney disease, dialysis is essential but must be combined with other therapies for optimal control. While controlling phosphorus levels can be a challenge, adherence to a personalized treatment plan is the best way to prevent the serious long-term complications associated with hyperphosphatemia and improve overall quality of life.

For more detailed information on managing chronic kidney disease, visit the National Kidney Foundation's resources: https://www.kidney.org/kidney-topics/high-phosphorus-hyperphosphatemia

Frequently Asked Questions

The most common cause of high phosphorus, also known as hyperphosphatemia, is advanced chronic kidney disease (CKD). When kidneys are damaged, they cannot effectively filter and remove excess phosphorus from the blood.

Phosphate binders are medications taken with meals that act like a sponge, binding to the phosphorus in food before it can be absorbed by the body. The bound phosphorus is then removed from the body with the stool.

No, not all phosphorus is absorbed equally. Inorganic phosphorus, found in processed food additives, is almost entirely absorbed. In contrast, organic phosphorus, found naturally in foods like meat and nuts, is absorbed less efficiently.

Foods high in inorganic phosphorus include processed meats, fast food, bottled and canned drinks (especially dark colas), and many packaged snack foods. Natural, high-protein foods like dairy, nuts, and legumes also contain phosphorus, but their intake should be managed with a dietitian.

Yes, chronically high phosphorus levels can cause calcium deposits to form in the heart and blood vessels. This arterial calcification increases the risk of heart attack, stroke, and overall cardiovascular mortality.

Dialysis is a treatment for end-stage renal disease that helps remove waste products, including excess phosphorus, from the blood. However, for most dialysis patients, it must be combined with a low-phosphorus diet and phosphate binders to achieve adequate control.

Common side effects can include gastrointestinal issues like nausea, constipation, or diarrhea. Certain binders, such as calcium-based ones, can also increase the risk of hypercalcemia, or high calcium levels.