Phosphate balance in ESRD: diet, dialysis and binders against the low evident masked pool

Galassi, Andrea; Cupisti, Adamasco; Santoro, Antonio; Cozzolino, Mario

doi:10.1007/s40620-014-0142-4

Cited by 40 publications

(46 citation statements)

References 105 publications

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“…Disorders of phosphorus metabolism among ESRD patients are common, with serum phosphorus levels in PD patients generally lower than in hemodialysis (HD) patients [6,7,8], though treatment with oral phosphate binders are usually indicated [9]. Favorable properties of phosphate binders would include low pill burden, low cost, minimal systemic absorption, and minimal side effects [6,10]. Potential risks include toxicity, gastrointestinal side effects, and contribution to hypercalcemia [11,12,13].…”

Section: Introductionmentioning

confidence: 99%

Real-World Scenario Improvements in Serum Phosphorus Levels and Pill Burden in Peritoneal Dialysis Patients Treated with Sucroferric Oxyhydroxide

Kalantar-Zadeh

Parameswaran²,

Ficociello³

et al. 2018

Am J Nephrol

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Background: A database analysis was conducted to assess the effectiveness of sucroferric oxyhydroxide (SO) on lowering serum phosphorus and phosphate binder (PB) pill burden among adult peritoneal dialysis (PD) patients prescribed SO as part of routine care. Methods: Adult PD patients (n = 258) prescribed SO through a renal pharmacy service were analyzed. Baseline was 3 months before SO prescription. SO-treated follow-up was for 6 months or until either a new PB was prescribed, SO was not refilled, PD modality changed, or patient was discharged. In-range serum phosphorus was defined as ≤5.5 mg/dL. Results: At baseline, mean serum phosphorus was 6.59 mg/dL with 10 prescribed PB pills/day. The proportion of patients achieving in-range serum phosphorus increased by 72% from baseline to month 6. Prescribed PB pills/day decreased by 57% (10 at baseline to 4.3 at SO follow-up, p < 0.0001). The mean length of SO follow-up was 5.1 months; SO follow-up ended for 38, 27, and 50 patients at months 4, 5, and 6, respectively, due to no further PB fills, and for 10, 11, and 4 patients at months 4, 5, and 6, respectively, due to another PB prescribed. In patients with baseline serum phosphorus >5.5 mg/dL who achieved in-range serum phosphorus during SO follow-up for ≥1 quarter, a notable improvement in serum phosphorus (6.54 to 5.10 mg/dL, p < 0.0001) was observed, and there was a 53% reduction in PB pill burden (9.9 to 4.7, p < 0.0001). Conclusion: Among PD patients prescribed SO as part of routine care, improvements in serum phosphorus control and >50% reduction in PB pills/day were observed.

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Section: Introductionmentioning

confidence: 99%

Real-World Scenario Improvements in Serum Phosphorus Levels and Pill Burden in Peritoneal Dialysis Patients Treated with Sucroferric Oxyhydroxide

Kalantar-Zadeh

Parameswaran²,

Ficociello³

et al. 2018

Am J Nephrol

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“…Routinely, nephrologists try to counteract the positive phosphate (Pi) balance in advanced CKD patients by nutritional counseling, dialysis efficiency, and Pi binders prescription [2].…”

Section: Introductionmentioning

confidence: 99%

A new in vitro model to delay high phosphate-induced vascular calcification progression

et al. 2015

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An increasing amount of patients affected by advanced chronic kidney disease suffer from vascular calcification (VC) that associates with cardiovascular morbidity and mortality. In this study, we created a new experimental in vitro model, trying to better elucidate high phosphate (Pi)-induced VC pathogenic mechanisms. Rat aortic vascular smooth muscle cells (VSMCs) were challenged for 7-10 days with high Pi with a repeated and short suspensions of high Pi treatment (intermittent suspension, IS) that was able to induce a significant inhibition of high Pi calcification, maximal at 5 h. Interestingly, the delay in calcification is a consequence of either the absence of free Pi or calcium-phosphate crystals being comparable to the total effect obtained during the 5 h-IS. The protective effect of IS was mediated by the reduction of apoptosis as demonstrated by the action of 20 μmol/L Z-VAD-FMK and by the preservation of the pro-survival receptor Axl expression. Furthermore, autophagy, during IS, was potentiated by increasing the autophagic flux, evaluated by LC3IIB western, while treating VSMCs with 1 mmol/L valproic acid did not affect VC. Finally, IS prevented VSMC osteoblastic differentiation by preserving smooth muscle lineage markers expression. Our data support the hypothesis that to delay significantly VC is necessary and sufficient the IS of high Pi challenge. The IS was able to prevent significantly apoptosis, to induce a potentiation in autophagy, and to prevent osteoblastic differentiation by preserving SM lineage markers.

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“…However, the superiority against placebo of phosphate control by diet or binders in terms of survival has never been tested in randomized controlled trials (RCTs). There is a rationale supporting the value of a simultaneous intervention against phosphate overload in patients with CKD via the improvement of dietary intake and an individualized choice of phosphate binders (32).…”

Section: How Should Normal Serum Phosphate Be Achieved?mentioning

confidence: 99%

Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD

Bellizzi

Carrero

Chauveau

et al. 2016

Nephrology @ Point of Care

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This is a case report on a patient with non-dialysis chronic kidney disease (CKD) in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2 nd International Conference of the European Renal Nutrition working group at ERA-EDTA-"Retarding CKD progression: readily available through comprehensive nutritional management?"-and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections-basic nutritional assessment, nutritional targets, and nutritional follow-up in non-dialysis CKD-linked to 3 consecutive steps of the clinical follow-up of the patient and the related nutritional concerns and intervention. First visit: Baseline nutritional assessment and basic nutritional considerations in non-dialysis chronic kidney disease (CKD)• What nutritional assessment/monitoring for protein-energy wasting (PEW) should be employed?• Is a body mass index (BMI) of 21 kg/m 2 adequate? • What phosphate target should be pursued?• What are the nutritional habits in patients with incident CKD?• What protein needs and amount of dietary protein should be pursued?• Does the quality of protein matter?• What amount of dietary salt should be employed? How should this be obtained?• How should normal serum phosphate be achieved?• What diet should be recommended? Is a vegetarian diet an option?

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Phosphate balance in ESRD: diet, dialysis and binders against the low evident masked pool

Cited by 40 publications

References 105 publications

Real-World Scenario Improvements in Serum Phosphorus Levels and Pill Burden in Peritoneal Dialysis Patients Treated with Sucroferric Oxyhydroxide

Real-World Scenario Improvements in Serum Phosphorus Levels and Pill Burden in Peritoneal Dialysis Patients Treated with Sucroferric Oxyhydroxide

A new in vitro model to delay high phosphate-induced vascular calcification progression

Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD

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