The National Institute for Health and Clinical Excellence has published its first clinical guideline on the management of hyperphosphataemia in late-stage kidney disease, which aims to standardise treatment of the condition and achieve better outcomes for patients.
Chronic kidney disease (CKD) is a common cause of hyperphosphataemia - when phosphate levels in the blood are too high - which can lead to symptoms such as bone pain and muscle weakness, deterioration of kidney function, and even premature death.
Up to 520,000 people in England alone are being treated for stages 4 and 5 CKD, but only 61% of patients on haemodialysis and 70% of those receiving peritoneal dialysis are achieving phosphate levels within the recommended range, which is believed to be down to variation in practice and highlights the significant scope for improvement.
The guideline, the first to be produced by NICE for this specific condition, is designed to ensure that all patients receive the best care possible, and has been produced "in the face of varying standards of practice and the type of treatments people with the condition receive, together with a steady rise in the number of people with CKD," said Professor Mark Baker, Director of the Centre for Clinical Practice at the Institute.
Sanofi's unlicensed Renvela endorsed
Recommendations include giving children a calcium-based phosphate binder as first-line treatment, and adding or switching to sevelamer hydrochloride (Sanofi's Renvela) - which does not hold a specific UK license for this but is commonly used in practice - if levels remain too high.
For adults, calcium acetate should be offered as a first-line phosphate binder to control phosphate levels in addition to dietary management, with calcium carbonate the second choice where necessary, NICE said.
Elsewhere, the guidelines state that a specialist renal dietician should carry out an assessment and provide tailored information on phosphate management through diet, and that the control of phosphate levels should be checked at every routine clinical review.
All-in-all, if followed, the recommendations "should reduce variation in clinical practice and lead to better outcomes for patients with this condition," conclded Indranil Dasgupta, consultant nephrologist at Heartlands Hospital in Birmingham, who helped develop the guideline.