Comparative Effectiveness of Calcium-Containing Phosphate Binders in Incident U.S. Dialysis Patients

Winkelmayer, Wolfgang C.; Li, Jun; Kestenbaum, Bryan

doi:10.2215/cjn.05060610

Cited by 41 publications

(29 citation statements)

References 19 publications

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“…40 In a study on 3,603 incident dialysis patients, 77.5% used a calcium-based binder, while 22.5% did not. Baseline use of calcium-based binders was associated with an adjusted 19% lower mortality rate compared …”

Section: Calcium-based Phosphate Bindersmentioning

confidence: 99%

“…No mortality differences were observed between calcium acetate and calcium carbonate users in crude, adjusted, or propensitymatched analyses. 40 A more recent calcium-based formulation comprises calcium acetate and magnesium carbonate (CaMg). In a randomized controlled study comparing CaMg and calcium carbonate, lower P and calcium levels were observed in the group of patients treated with CaMg.…”

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confidence: 99%

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Phosphate control in dialysis

Cupisti¹,

Gallieni²,

Rizzo³

et al. 2013

IJNRD

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Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease-mineral and bone disorder (CKD-MBD) management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive-convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P) mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200-300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source. Finally, boiling should be the preferred cooking procedure, because it induces food demineralization, including phosphate loss. The integrated approach outlined in this article should be actively adapted as a therapeutic alliance by clinicians, dieticians, and patients for an effective control of phosphate balance in dialysis patients.

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Section: Calcium-based Phosphate Bindersmentioning

confidence: 99%

mentioning

confidence: 99%

Phosphate control in dialysis

Cupisti¹,

Gallieni²,

Rizzo³

et al. 2013

IJNRD

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“…The authors speculated that the observation might be explained by modulation of direct effect of phosphorus or compensatory mechanisms such as FGF23 on patient survival [33]. However, this reduction in mortality was not observed in incident dialysis patients treated with calciumcontaining binders, either calcium acetate or calcium carbonate [34]. Phosphorus binders lower serum phosphorus and also lower FGF23 levels.…”

Section: Phosphorus Bindersmentioning

confidence: 99%

Nutrition Therapy For Liver Diseases Based On The Status Of Nutritional Intake

2013

Clinical Nutrition

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Patients with renal impairment progressively lose the ability to excrete phosphorus. Decreased glomerular filtration of phosphorus is initially compensated by decreased tubular reabsorption, regulated by PTH and FGF23, maintaining normal serum phosphorus concentrations. There is a close relationship between protein and phosphorus intake. In chronic renal disease, a low dietary protein content slows the progression of kidney disease, especially in patients with proteinuria and decreases the supply of phosphorus, which has been directly related with progression of kidney disease and with patient survival. However, not all animal proteins and vegetables have the same proportion of phosphorus in their composition. Adequate labeling of food requires showing the phosphorus-to-protein ratio. The diet in patients with advanced-stage CKD has been controversial, because a diet with too low protein content can favor malnutrition and increase morbidity and mortality. Phosphorus binders lower serum phosphorus and also FGF23 levels, without decreasing diet protein content. But the interaction between intestinal dysbacteriosis in dialysis patients, phosphate binder efficacy, and patient tolerance to the binder could reduce their efficiency.

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“…It has been studied in many well-designed small pilot studies and the response to the agent correlates with a reduction in antibodies to the M-type phospholipase A2 receptor. [12][13][14][15] In this issue of JASN, Ruggenenti et al 16 describe the course of 100 patients with persistent, angiotensin converting enzyme inhibitor-treated, idiopathic membranous nephropathy given rituximab and followed over a median time of 29 months. The study includes 68 patients with new onset disease and 32 patients with prior immunosuppressive therapy.…”

Section: Disclosuresmentioning

confidence: 99%

“…They found, using different types of analyses, that treatment with phosphate binders was independently associated with decreased mortality risk compared with no treatment. However, Winkelmayer et al, 15 who compared use versus nonuse of calcium-containing phosphate binders in incident dialysis patients, did not observe any mortality differences, using multivariate and propensity score-matched Cox regression models.…”

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confidence: 95%