Hyperphosphatemia and phosphate binders: effectiveness and safety

Kalaitzidis, Rigas; Elisaf, Moses

doi:10.1185/03007995.2013.841667

Cited by 9 publications

(7 citation statements)

References 24 publications

(30 reference statements)

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“…Lanthanum ( Z =57) in the form of La 2 CO 3 (Fosrenol) was approved in 2004 for treatment of hyperphosphatemia [ 256 ], an electrolyte imbalance that results in elevated levels of phosphate in the blood. Hyperphosphatemia is more severe in patients suffering from renal failure as a result of increased FGF-23 levels, secondary hyperparathyroidism and enhanced progressive vascular calcification [ 257 ]. Fosrenol acts as a phosphate binder, reducing absorption of phosphate through the formation of insoluble lanthanum phosphate complexes which can then pass through the grastrointestinal tract unabsorbed [ 258 ].…”

Section: Groups 3–12: the Transitions Metalsmentioning

confidence: 99%

The elements of life and medicines

Chellan

Sadler

2015

Phil. Trans. R. Soc. A.

192

117

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Which elements are essential for human life? Here we make an element-by-element journey through the periodic table and attempt to assess whether elements are essential or not, and if they are, whether there is a relevant code for them in the human genome. There are many difficulties such as the human biochemistry of several so-called essential elements is not well understood, and it is not clear how we should classify elements that are involved in the destruction of invading microorganisms, or elements which are essential for microorganisms with which we live in symbiosis. In general, genes do not code for the elements themselves, but for specific chemical species, i.e. for the element, its oxidation state, type and number of coordinated ligands, and the coordination geometry. Today, the biological periodic table is in a position somewhat similar to Mendeleev's chemical periodic table of 1869: there are gaps and we need to do more research to fill them. The periodic table also offers potential for novel therapeutic and diagnostic agents, based on not only essential elements, but also non-essential elements, and on radionuclides. Although the potential for inorganic chemistry in medicine was realized more than 2000 years ago, this area of research is still in its infancy. Future advances in the design of inorganic drugs require more knowledge of their mechanism of action, including target sites and metabolism. Temporal speciation of elements in their biological environments at the atomic level is a major challenge, for which new methods are urgently needed.

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Section: Groups 3–12: the Transitions Metalsmentioning

confidence: 99%

The elements of life and medicines

Chellan

Sadler

2015

Phil. Trans. R. Soc. A.

192

117

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“…Phosphatebinders have different effects on FGF-23 levels. Recent studies showed that lanthanum carbonate and sevelamer were effective in reducing FGF23 levels; this effect was not observed with calcium carbonate (14,15) (19).…”

Section: Resultsmentioning

confidence: 99%

The Relationship Between Arterial Stifness and 25-(Oh) Vitamin D, FGF 23 in Maintenance Hemodialysis Patients

Karakose

Bal

Sayın

et al. 2020

Ankara Eğitim Ve Araştırma Hastanesi Tıp Dergisi

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AIM: Vascular calcification (VC) is highly prevalent in maintenance hemodialysis (MHD) population and increasing evidence indicates that abnormalities in mineral metabolism are closely associated with VC and increased mortality in chronic kidney disease (CKD) patients. In our study, we aimed to determine whether high Fibroblast growth factor-23 (FGF-23) and low 25 (OH) Vitamin D levels are a result of high calcium load and whether there is a relationship between 25 (OH) Vitamin D levels and arterial stiffness in CKD patients. MATERIAL AND METHODS:One hundred and seventeen patients who were receiving MHD 3 times a week for at least 24 months were selected and followed up for 12 months and laboratory results were recorded from patient files. We analyzed the influence of a yearlong cumulative calcium and therapeutic vitamin D (paricalcitol and calcitriol) intake and serum FGF-23 level on endogenous 25(OH)D levels and the impacts of these parameters on the change in annual pulse wave velocity (PWV) measurement results in MHD patients. RESULTS:Elementary calcium dose was significantly higher in vitamin D insufficiency group than control group (P=0.014). Serum levels of FGF-23 were positively correlated with duration of HD (P=0.001), mean parathyroid hormone (PTH) (P=0.001), mean phosphorus (P) (P=0.009) and mean CaXP (P=0.006). Baseline PWV measurement were similar between two groups, however patients in insufficiency group had higher 12th month PWV measurements compared to control group (P=0.034). CONCLUSION:Calcium could increase serum FGF23 levels by indeterminate mechanisms independently of serum phosphorus level. Additionally, elevated FGF-23 level was found to be insulting a decline in vitamin D levels which may cause VC and stiffening of the arteries and resulting higher PWV measurements.

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“…In humans there is evidence that hyperphosphatemia is associated with vascular calcification and nephrocalcinosis, with a subsequent more rapid disease progression [19]. The situation in cats appears to be different.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a Feed Supplement in Advanced Stages of Feline Chronic Kidney Disease

Vergnano

Valle

Bruni³

et al. 2016

Acta Scientiae. Vet.

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Background: Chronic kidney disease (CKD) is a very common pathology in cats, especially in the geriatric age. A proper renal diet is considered the current standard of care to enhance patients’ long-term survival and quality of life. However, when diet alone is not sufficient, it is necessary to supplement it with specific substances: these are phosphate binders and alkalinizing agents. The aim of this study was to evaluate the effectiveness of a feed supplement containing calcium carbonate, calcium lactate gluconate, chitosan and sodium bicarbonate in controlling hyperphosphatemia and metabolic acidosis in cats with severe CKD (IRIS, International Renal Interest Society, stage 3 and 4).Materials, Methods & Results: 10 cats (median BW 4.00 (3.20; 5.70) Kg, BCS 3/5 (2.25; 3.75), 11 (8.25;12.00) years) fed with a balanced renal diet were included in the study. To be enrolled in the study cats had to be affected by CKD in stages 3 or 4 and show hyperphosphatemia. Treatment consisted in oral administration of the product (Renal, Candioli Pharma) at 0.2 g/kg/day mixed with the food for 60 days. The animals were evaluated at the beginning of the study and at 15, 30, 60 days (T0, T15, T30, T60) for: clinical condition, BW, BCS, blood pressure and for routinely hematochemical, biochemical and urinary parameters. Owners were asked to assess appetite of the cat, palatability of the supplement, presence of vomit and/or diarrhoea, general health and vitality. All statistical analyses were performed using SAS software. After checking normality data were analyzed using Kruskal-Wallis and Wilcoxon tests. Results are expressed as median (interquartile range). For the parameters P (P < 0.0001), iCa (P = 0.0008) and HCO3 (P = 0.0002) there were statistically significant differences among times of supplementation (T0, T15, T30, T60). Statistically significant reduction of serum phosphorus concentration was obtained through the study (reduction of 59% at T60 vs T0). Also a statistically significant increase of bicarbonate was seen (7% from T0 to T60). At T60 was also recorded an increase of ionized calcium level, which however was in normal range. For the other laboratory parameters, no statistical difference was recorded. All the owners reported a good palatability of the product. The decrease of vomit and diarrhea episodes and the increase of the appetite reported were statistically significant (P < 0.05).Discussion: The restriction of available dietary phosphorus is now recognised as one of the major contributors in slowing the disease progression and improving survival rates. Phosphate binders are able to absorb phosphate (P) in the intestine, forming insoluble products that are eliminated with the faeces, thus decreasing serum phosphate levels. The phosphate binders contained in the product tested in the present trial were chitosan, calcium lactate gluconate and calcium carbonate. During the study P decreased significantly from T0 to T60, reaching the target post-treatment plasma P concentration for IRIS stage 3 after 30 days. Another important recommendation for CKD treatment is to use alkalinisation therapy if metabolic acidosis is present. The feed supplement tested in this study also contained sodium bicarbonate. In our study, 90% of the patients at the inclusion examination had metabolic acidosis. At the end of the study, the median blood bicarbonate concentration was in the normal range, thus reaching the IRIS treatment target. The feed supplement tested was therefore effective in reducing blood phosphate levels and in increasing blood bicarbonate levels, thus improving the cats’ clinical conditions for the duration of the study without any adverse effect.

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Hyperphosphatemia and phosphate binders: effectiveness and safety

Cited by 9 publications

References 24 publications

The elements of life and medicines

The elements of life and medicines

The Relationship Between Arterial Stifness and 25-(Oh) Vitamin D, FGF 23 in Maintenance Hemodialysis Patients

Effectiveness of a Feed Supplement in Advanced Stages of Feline Chronic Kidney Disease

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