Phosphorus is a vital mineral that produces cellular energy in our body and forms bone structure. Elevated phosphorus in blood tests (hyperphosphatemia) indicates that the kidneys have lost their filtering function, causing the mineral to accumulate in the blood and increasing the risk of vascular calcification; while low phosphorus (hypophosphatemia) means that, due to malnutrition or absorption problems, the muscles and bones become weakened at the cellular level by being left without energy. In order for metabolism, nerve conduction and the skeletal system to function in a healthy way, this mineral balance in the blood must be maintained at a millimetric level. Values moving outside normal reference ranges are a critical health indicator that directly triggers cellular aging and deterioration in organ functions.
What Basic Functions Does Phosphorus Undertake in Our Body?
Approximately eighty-five percent of the phosphorus found in the body of a healthy adult combines with the mineral calcium and is stored in crystalline form in the structure of the bones and teeth.
The main element that enables the skeletal system to be durable and hard like a framework is this perfect combination of calcium and phosphorus. The remaining fifteen percent is found like an invisible system manager in intracellular fluids, in the structure of the fat layers that form cell membranes, and in the backbone of the DNA and RNA molecules that carry our entire genetic code.
Phosphorus is absolutely necessary for the continuation of life and vitality at the cellular level. The trillions of cells in our body need constant energy in order to carry out the tasks assigned to them. This cellular-level energy currency of the human body is the molecule Adenosine Triphosphate, briefly known as ATP. The production of ATP and making this energy available for use directly depend on the presence of phosphorus. This molecule, which works almost like the rechargeable batteries of the body, cannot function without phosphorus.
In addition, the regular transmission of electrical signals between billions of nerve cells in the nervous system, the repair of muscle tissues that become tired as a result of daily activities, and the processes by which the kidneys filter harmful metabolic waste from the blood and remove it from the body also take place with the help of phosphorus. The balancing power of phosphorus is also needed in the background for other nutrients of critical importance to our body, such as vitamin D, calcium, magnesium and zinc, to become biologically active and perform their own functions.
What Should the Ideal Phosphorus Level Be in a Healthy Individual and How Does It Remain Balanced?
For an adult individual, in other words people aged nineteen and over, taking an average of seven hundred milligrams of phosphorus in the daily diet is generally sufficient to meet the body’s daily needs. In a healthy metabolism, the phosphorus concentration measured in blood tests is kept within a very narrow and extremely sensitive range such as 2.8 to 4.5 mg/dL. In order to protect this narrow range, the body has established a perfectly functioning thermostat system within itself.
Maintaining this sensitive balance depends on strong communication established between the intestines, bones and kidneys. Phosphorus in the foods we eat is absorbed from the intestines and enters the bloodstream, its excess is stored in the bones as a reserve depot or filtered through the kidneys and excreted in the urine. The harmonious functioning between these three centers is managed by a dynamic hormonal network.
Parathyroid hormone secreted from the small parathyroid glands located in the neck region, certain special growth factors secreted from bone cells and vitamin D activated in the kidneys are in constant communication to adjust the amount of phosphorus circulating in the blood at a millimetric level. Thanks to this flawless communication network, excess phosphorus taken during the day is rapidly excreted from the kidneys, while in the event of any deficiency, phosphorus is drawn from the stores in the bones into the blood, ensuring that the system continues to operate without interruption.
What Causes Low Phosphorus (Hypophosphatemia) and What Symptoms Does It Produce?
The condition in which the inorganic phosphorus level measured in blood tests falls below the limit of 2.8 mg/dL is clinically called hypophosphatemia. The insufficient presence of phosphorus in the blood is generally directly related to people’s daily lifestyle habits and some chronic health problems they have. In particular, not getting enough mineral through nutrition or not being able to retain the mineral taken in the body is one of the most common problems.
The main factors that pave the way for the development of hypophosphatemia are:
- Inadequate nutrition
- Unbalanced nutrition
- Chronic alcohol use
- Hyperthyroidism
- Use of antacids
- Use of stomach protectors
A decrease in the phosphorus level in the blood means that ATP stores, the energy-producing battery of the body, are rapidly depleted. A body whose energy is exhausted naturally begins to experience a major crisis. Since a sufficient calcium and phosphorus combination cannot be provided, bone tissue gradually begins to soften and lose its durability. Over time, this softening may cause bone curvatures and posture disorders. In severe untreated cases, even the respiratory and heart muscles may be seriously weakened by this lack of energy.
Common symptoms that may be seen in people experiencing low phosphorus are as follows:
- Fatigue
- Weakness
- Joint stiffness
- Bone pain
- Muscle weakness
- Skeletal deformities
- Respiratory failure
- Heart failure
- Neurological seizures
- Coma
What Causes High Phosphorus (Hyperphosphatemia) and Which Diseases Does It Originate From?
The condition in which the amount of phosphorus in the blood exceeds the upper limit of 4.5 mg/dL and accumulates is defined as hyperphosphatemia and is definitely a condition that must be followed closely. The best-known and most common responsible factor for this condition is the kidneys beginning to lose their filtering ability. When the kidneys cannot fully perform their function, excess phosphorus entering the body cannot be cleaned from the blood and excreted in the urine, and therefore continues to circulate in the blood vessels.
The main health problems and conditions that lead to high phosphorus are:
- Chronic kidney failure
- Excessive vitamin D consumption
- Calcium deficiency
- Magnesium deficiency
- Diabetic ketoacidosis
- Hypoparathyroidism
- Liver diseases
- Tumor lysis syndrome
Vitamin D supplements taken externally in an unconscious and very high-dose manner may abnormally increase the amount of phosphorus passing from the intestines into the blood, bringing blood levels to dangerous dimensions. During cancer treatments, as a result of cancerous cells breaking down very rapidly under the effect of chemotherapy drugs, the large amount of phosphorus inside the cells suddenly empties into the blood and causes a serious elevation.
What Destructive Effects Does High Phosphorus Cause in Bones and Muscles?
Phosphorus circulating in the blood in much higher amounts than normal does not, by its nature, like to remain alone in a free state. During blood flow, it tightly attaches to free calcium elements it encounters and turns into calcium-phosphate salts. As a result of phosphorus virtually trapping calcium within itself, the amount of free calcium in the blood that cells can use suddenly and rapidly begins to decrease.
This calcium drop completely disrupts the electrical conduction settings of the muscle and nervous system. Severe muscle spasms, painful and involuntary contractions, tingling in the fingertips and toes, and life-threatening heart rhythm abnormalities may occur in patients. The situation takes on a very different dimension, especially in people with chronic kidney disease. When the calcium level in the blood remains constantly low, the parathyroid glands located in our neck go into an alarm state to correct this condition.
In order to meet the calcium needs of the blood, the parathyroid glands begin to produce excessive amounts of hormone. This intense hormone that is secreted begins to, in a sense, melt the body’s own bones in order to urgently provide calcium to the blood. As calcium is removed from the bones and enters the blood, the inside of the bones is almost hollowed out and the skeletal system weakens. As this destructive process continues, severe conditions that considerably reduce patients’ quality of life occur.
Complications that develop due to bone loss and mineral disorder are:
- Bone pain
- Bone deformities
- Pathological fractures
- Renal osteodystrophy
- Shortening of height
- Joint calcifications
How Does High Phosphorus Cause Vascular Calcification?
Perhaps the most insidiously progressing and life-threatening result of high phosphorus is the damage it creates on the vessels. The salts formed by phosphorus and calcium combining in the blood begin to precipitate on the inner walls of blood vessels, just like hard limestone deposits that accumulate over time inside the water pipes in our homes and clog the pipes.
In the medical world, this condition is called vascular calcification.
Arteries that should normally have an elastic structure lose their elasticity due to this lime layer, harden and become rigid like a pipe. This process, called vascular stiffness, makes blood flow difficult. Moreover, this calcification does not remain limited only to the vessels; it also settles on the heart valves that open and close like a door inside the heart, disrupting the heart’s function of pumping blood with sufficient strength.
Especially when this calcification occurs in the coronary vessels that feed the heart, it increases the risk of stroke, paralysis and heart attack to very serious levels compared to healthy individuals. Sometimes the calcification reaches such advanced dimensions that the tiny capillaries feeding the skin become completely blocked. In this case, because blood cannot reach the tissues, extremely painful, black-colored and very deep wounds that take months to heal occur on the skin. In order to protect vascular and heart health, excess phosphorus accumulated in the blood must absolutely be brought under control.
How Are Parathyroid Glands Enlarged Due to High Phosphorus Treated Without Surgery?
In patients undergoing dialysis treatment or with chronic kidney failure, the parathyroid glands become tired from constantly producing hormones due to the calcium and phosphorus imbalance and, over time, begin to grow out of control.
Traditionally, the treatment of this condition is the surgical removal of the enlarged glands through an operation performed in the neck region. However, for patients with kidney problems, calcified vessels and poor general health, receiving general anesthesia (narcosis) and lying on the operating table may carry very high risks.
At exactly this point, non-surgical treatment options applied by interventional radiology specialists, an innovative branch of modern medicine, come to the forefront. While interventional radiologists monitor the neck region on the screen with high-resolution ultrasound devices, they can solve this problem without any surgical incision or suturing procedure, by only numbing that area (local anesthesia). Methods called thermal ablation are frequently used today to intervene in enlarged parathyroid glands.
In these methods called Radiofrequency Ablation or Microwave Ablation, the exact center of the enlarged parathyroid gland is entered directly through the skin with an extremely thin and specially manufactured needle. The tip of this needle creates controlled heat within the tissue using radiofrequency waves or microwave energy. By gradually increasing the temperature, the overactive cells of the parathyroid gland are almost dried out and their functions are safely terminated.
The neck region is an area through which very sensitive nerves that control the vocal cords pass. In order to prevent these nerves from being damaged while heat energy is applied, a very special and clever protection method called hydrodissection is used. Just before the procedure, fluid is injected between the gland and the nerve, placing a kind of water cushion there. This fluid barrier completely prevents the heat from spreading to the surrounding area and protects the vocal cords one hundred percent. In smaller enlargements, the gland may also be reduced by entering the gland with a needle and injecting pure alcohol. Patients return home walking on the same day and the recovery process is followed by blood tests performed at certain intervals.
How Are Leg Vessels Calcified as a Result of High Phosphorus Opened Without Surgery?
When vascular calcification triggered by high phosphorus in the blood settles in the arteries of the legs, patients’ daily walking distances become seriously shorter. Since enough blood carrying the oxygen needed by the leg muscles cannot reach them, patients experience very severe cramp-like pain in their legs after walking a little, making them feel the need to stop and rest. If left untreated, these pains continue even while lying down at night and, worst of all, may turn into wounds on the toes that are impossible to heal and into gangrene.
In the past, bypass surgeries in which the leg was opened like open-heart surgery were performed to open such calcified hard vessels. However, in interventional radiology angiography rooms, these petrified vessels can now be opened without surgery, only with local anesthesia and by entering through a needle hole. The most commonly applied modern method for calcified vessels is vessel shaving, medically called atherectomy.
In this procedure, entry is made through the vessel in the groin region with a very thin catheter that has a specially designed tip, and it is advanced to the blocked or narrowed area. When this smart catheter comes into contact with the hard calcified layers stuck to the vessel wall, it begins to work almost like a microscopic shaver. It cleans the calcified layers by scraping them from the vessel wall millimeter by millimeter. Its most important feature is that it collects the calcified particles it scrapes into a special chamber inside itself in order to prevent them from mixing into the bloodstream and blocking other vessels.
While in balloon expansion procedures the calcification is only crushed toward the vessel wall, in the shaving procedure the calcification blocking the vessel is completely removed from the body. Thus, it is generally not necessary to leave a permanent metal piece (stent) inside the vessel. After the cleaning process, the procedure is completed by making a final expansion with special drug-coated balloons so that the inside of the vessel remains smooth. Thanks to this method, which does not require any stitches, patients can usually return home after being kept under observation for only a few hours.
What Is Done When Dialysis Fistulas Affected by High Phosphorus Become Blocked?
The process of cleaning the blood of patients whose kidneys do not work with the help of machines is called hemodialysis. In order for the patient to be connected to the dialysis machine, a special vascular access is created in the arm through a small surgical procedure in which an artery and a vein are joined; this is called a dialysis fistula.
These fistulas are literally the lifelines through which dialysis patients hold on to life. However, high phosphorus in the blood and harmful substances that cannot be excreted by the kidneys irritate the inner surface of these special vessels over time, calcify them and cause narrowing.
When the vessel narrows, blood flow slows down and this may lead to clotting of the blood, resulting in complete blockage of the fistula. A non-functioning fistula means that the patient cannot undergo dialysis, so this condition is a medical alarm requiring urgent intervention. Interventional radiology clinics offer fast and effective solutions to save blocked or narrowed fistulas without surgery. In the first stage, using ultrasound and angiography devices, a map of the fistula is created with a drug given into the vessel and the exact location of the narrowing is determined.
If there is a narrowing inside the fistula, a tiny balloon is placed in that area with the guidance of guidewires as thin as a strand of hair. The balloon is inflated in the narrowed area, opening the contraction in the vessel wall and allowing blood to flow easily again. This procedure is called fistuloplasty. Sometimes fistulas newly opened by surgeons but unusable because they have not developed sufficiently can also be widened with this balloon and made suitable for dialysis.
If the fistula is completely blocked due to a clot, special clot-dissolving drugs are injected directly into the clot without the need for surgery again. Alternatively, the clot is broken down with mechanical tools resembling a small vacuum device and sucked out from inside the vessel. Thanks to these interventions performed within minutes, a fistula thought to have completed its life can be revived and it is ensured that the patient continues dialysis treatment without interruption.
Which Methods Are Used If Vascular Access Cannot Be Opened in Dialysis Patients with Impaired Phosphorus Balance?
In some cases, patients’ arm vessels may be structurally very thin, delicate or very worn due to previous procedures. In such a situation, it is not possible to create a dialysis fistula in the arm. Sometimes the patient must undergo dialysis urgently, and there is no time of weeks to wait for a newly opened fistula to mature and become usable. In such cases, permanent dialysis catheters are placed in the large main veins in the neck or chest region in order to carry the blood to the dialysis machine.
This placement procedure is carried out in angiography room conditions, in a fully sterile environment, with great care under the guidance of fluoroscopy and ultrasound devices. Thanks to imaging devices, the physician clearly sees the vessel on the screen and enters the vessel in a single move without damaging any surrounding tissue. The end of the catheter that remains outside is not taken out directly from the point where it enters the vessel. In order to bring the infection risk close to zero, a small tunnel is created under the skin and the catheter is directed from under the collarbone toward the chest region.
There is a specially designed, felt-like small structure on the body of these permanent tunneled catheters. This felt integrates with the subcutaneous tissue within a short time and forms a biological plug there. Thanks to this natural barrier, microbes that may come from outside are prevented from reaching the vessel. After the catheter is placed, it is confirmed by an imaging method that its tip is exactly where it should be, toward the entrance of the heart. The catheter, whose inside is filled with a blood thinner, becomes safely ready for use in dialysis procedures from that moment on.
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