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Like many patients on peritoneal dialysis, I am taking a phosphorous binder, for me named Velphoro. I chew at least two of these horse-sized yuk wafers with my breakfast and sometimes with a meaty meal. At present, I receive them via my military pharm, ExpressScripts at about $38.00 for 3 month’s supply.

Saturday I received a postcard-type communication from Fresenius stating that starting 1/1/2025, binders would be covered as part of Medicare (part B.) My RX will be transferred to FreseniusRx from some point on. The cost henceforth should be mapped into my overall PD coverage by Medicare/Tricare for Life. No more $38. To provide background to those, not of the community and question what is this phosphorous thing all about, read on..

Excessive phosphorus levels (hyperphosphatemia) can present several complications for patients on peritoneal dialysis:

Cardiovascular Complications

Hyperphosphatemia is associated with increased cardiovascular morbidity and mortality in peritoneal dialysis patients[1][3]. It contributes to:

  • Vascular calcification
  • Arterial stiffness
  • Increased risk of cardiovascular events

Bone and Mineral Disorders

Too much phosphorus disrupts normal bone and mineral metabolism, leading to:

  • Secondary hyperparathyroidism
  • Renal osteodystrophy
  • Increased risk of bone fractures

Soft Tissue Calcification

Excess phosphorus can cause calcium-phosphate deposits to form in soft tissues throughout the body, including:

  • Blood vessels
  • Heart valves
  • Joints
  • Skin

Anemia

Hyperphosphatemia may contribute to anemia in peritoneal dialysis patients by:

  • Interfering with erythropoiesis
  • Shortening red blood cell survival

Itching

Many peritoneal dialysis patients with high phosphorus levels experience severe itching (pruritus), which can significantly impact quality of life.

Nutritional Issues

Dietary phosphorus restriction, often necessary to control levels, can lead to:

  • Protein malnutrition
  • Muscle wasting
  • Overall poor nutritional status

Proper management of phosphorus levels through dialysis prescription, diet, and medications is crucial for peritoneal dialysis patients to prevent these complications and improve outcomes[2]. Regular monitoring of phosphate clearance and serum levels is important, as peritoneal dialysis may provide less effective phosphorus removal compared to hemodialysis in some patients[4].

Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10386128/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737570/
[3] https://www.nature.com/articles/s41598-020-74412-2
[4] https://academic.oup.com/ndt/article/31/9/1508/1751782
[5] https://www.sciencedirect.com/science/article/pii/S0085253815528755
[6] https://www.mayoclinic.org/tests-procedures/peritoneal-dialysis/about/pac-20384725
[7] https://www.kidneyfund.org/living-kidney-disease/health-problems-caused-kidney-disease/high-phosphorus-hyperphosphatemia
[8] https://www.kidney-international.org/article/S0085-2538%2815%2952875-5/fulltext