What is the primary treatment for increased phosphate levels in ESRD?

In the context of end-stage renal disease (ESRD), the primary treatment for increased phosphate levels focuses on the use of oral phosphate binders. This approach is essential because, in ESRD, the kidneys lose the ability to excrete phosphate effectively, leading to hyperphosphatemia, which can cause various complications, including vascular calcification and second hyperparathyroidism.

Oral phosphate binders work by binding dietary phosphate in the intestines, preventing its absorption into the bloodstream. This helps to lower serum phosphate levels effectively and can improve the overall metabolic balance in patients with ESRD. Common classes of phosphate binders include calcium-based binders, metal-based binders (like sevelamer), and lanthanum carbonate.

While fluid restriction, diuretic therapy, and avoiding protein intake can play roles in managing other aspects of ESRD, they do not directly target elevated phosphate levels. Fluid restriction helps manage fluid overload, diuretic therapy primarily addresses volume overload and hypertension, and avoiding protein intake reduces urea production but does not have a direct effect on phosphate management. Thus, using oral phosphate binders specifically addresses the high phosphate levels characteristic of ESRD, making it the most appropriate treatment choice.