Phosphate control in dialysis

Cupisti, Adamasco; Gallieni, Maurizio; Rizzo, Maria Antonietta; Caria, Stefania; Meola, Mario; Bolasco, Piergiorgio

doi:10.2147/ijnrd.s35632

Cited by 61 publications

(66 citation statements)

References 88 publications

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“…For preplanned comparisons across dosing regimens, the 24-hour urine collections from the last 4 days of each period were examined. For comparisons with baseline, the individual results from all three dosing regimens for the last 4 days (days [19][20][21][22] were averaged and compared with the four baseline days (4-day analysis). To validate that the findings were not influenced by the short baseline period, a sensitivity analysis was conducted, in which the last 2 days of the baseline period were also compared with the last 2 days of the final treatment period (days 21 and 22) for urine excretion of K, Na, Ca, Mg, and P (2-day analysis).…”

Section: Methodsmentioning

confidence: 99%

Effect of Patiromer on Urinary Ion Excretion in Healthy Adults

Bushinsky

Spiegel²,

Gross³

et al. 2016

CJASN

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Background and objectives Patiromer is a nonabsorbed potassium-binding polymer that uses calcium as the counterexchange ion. The calcium released with potassium binding has the potential to be absorbed or bind phosphate. Because binding is not specific for potassium, patiromer can bind other cations. Here, we evaluate the effect of patiromer on urine ion excretion in healthy adults, which reflects gastrointestinal ion absorption.Design, setting, participants, & measurements We analyzed the effect of patiromer on urine potassium, sodium, magnesium, calcium, and phosphate in two studies. Healthy adults on controlled diets in a clinical research unit were given patiromer up to 50.4 g/d divided three times a day for 8 days (dose-finding study) or 25.2 g/d in a crossover design as daily or divided (two or three times a day) doses for 18 days (dosing regimen study). On the basis of 24-hour collections, urinary ion excretion during the baseline period (days 5-11) was compared with that during the treatment period (days 13-19; dose-finding study), and the last 4 days of each period were compared across regimens (dosing regimen study). ResultsIn the dose-finding study, patiromer induced a dose-dependent decrease in urine potassium, urine magnesium, and urine sodium (P,0.01 for each). Patiromer at 25.2 g/d decreased urine potassium (mean6SD) by 11406316 mg/d, urine magnesium by 4561 mg/d, and urine sodium by 2256145 mg/d. Urine calcium increased in a dose-dependent manner, and urine phosphate decreased in parallel (both P,0.01). Patiromer at 25.2 g/d increased urine calcium by 73623 mg/d and decreased urine phosphate by 64640 mg/d. Urine potassium, urine sodium, and urine magnesium were unaffected by dosing regimen, whereas the increase in urine calcium was significantly lower with daily compared with three times a day dosing (P=0.01). Urine phosphate also decreased less with daily compared with two or three times a day dosing (P,0.05).Conclusions In healthy adults, patiromer reduces urine potassium, urine sodium, urine magnesium, and urine phosphate, while modestly increasing urine calcium. Compared with divided dosing, administration of patiromer once daily provides equivalent reductions in urine potassium, urine sodium, and urine magnesium, with less effect on urine calcium and urine phosphate.

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Section: Methodsmentioning

confidence: 99%

Effect of Patiromer on Urinary Ion Excretion in Healthy Adults

Bushinsky

Spiegel²,

Gross³

et al. 2016

CJASN

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“…Studies show increased death risk as the result of hyperphosphatemia among patients under hemodialysis. One of the important solutions to achieve this goal is to receive balanced nutrition (18). Hyperkalemia, due to decreased potassium secretion, is also common among patients with CKD.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Nutrition Education Program on Biochemical Parameters Among Patients With Chronic Kidney Disease Undergoing Hemodialysis

Jahanpeyma¹,

Makhdoomi²,

Sajadi³

2017

Crit Care Nurs J

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Background: Nutrition is considered an important part of treatment in patients with chronic kidney disease (CKD). Therefore, poor nutrition leads to decreased life quality and increased complications of hemodialysis as well as mortality in these patients. This study aimed at investigating the effect of nutrition education program (NEP) on biochemical parameters among patients undergoing hemodialysis. Methods: This quasi-experimental study was conducted on 30 patients who referred to hemodialysis unit at Ayatollah Taleghani hospital in Urmia province, Iran. The sampling method was purposive. Data were collected through interviews and data collection instruments consisted of demographic questionnaires and checklist. In the pre-education stage, the demographic questionnaire was completed and a 2-month average of biochemical parameters (sodium, potassium, calcium, phosphor, blood urea nitrogen, and creatinine) were measured and recorded in the checklist by the researcher. Then, the patients received four 30-minute educational sessions on nutrition using learning assistant tools. Two months after the education program, the laboratory results were measured and recorded again by the researcher. Data analysis was performed using SPSS 14 and paired t test, and significance level was set at 0.05 (P < 0.5). Results:The findings revealed a significant decrease in sodium, potassium, calcium, blood urea nitrogen (P < 0.05), but no significant difference was found in the laboratory results of phosphor and creatinine (P < 0.05). Conclusions: The implementation of nutrition education program (NEP) for patients under hemodialysis can improve biochemical parameters as well as complications resulting from their imbalance. Therefore, this program is recommended for this group of patients.

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“…Previous studies have shown that PD is associated with more abnormalities in phosphorous and albumin than HD, especially once residual renal function has deteriorated. 21,22 Thus, it is possible that our data suggest that those PD patients who have difficulty controlling phosphorus or maintaining their albumin may be at increased risk of calciphylaxis.…”

Section: Calciphylaxis In Peritoneal Dialysismentioning

confidence: 94%

Calciphylaxis in peritoneal dialysis patients: a single center cohort study

Zhang¹,

Corapi²,

Luongo³

et al. 2016

IJNRD

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Background: Calciphylaxis is a rare but devastating condition in end-stage renal disease (ESRD) patients. Most research in the field of calciphylaxis is focused on hemodialysis (HD) patients; however, data on calciphylaxis incidence, risk factors, and mortality in peritoneal dialysis (PD) patients are limited. Methods: In this cohort study, we examined data from adult patients who initiated PD for ESRD management at our institute's PD unit from January 2001 to December 2015. Associations with the development of calciphylaxis were examined for clinical, laboratory, and medication exposures. Incidence of calciphylaxis and mortality in PD patients who developed calciphylaxis were analyzed. Treatments administered to treat calciphylaxis in PD patients were summarized. Results: In this cohort of 63 patients, 7 patients developed calciphylaxis (incidence rate: 9.0 per 1,000 patient-years). Median age of PD patients who developed calciphylaxis was 50 years, 57% were white, 71% females, and 71% were previously on HD. Female sex, obesity, HD as a prior dialysis modality, recurrent hypotension, elevated time-averaged serum phosphorous levels, reduced time-averaged serum albumin levels, and warfarin therapy were associated with increased calciphylaxis risk in univariate logistic regression analyses. Intravenous sodium thiosulfate was administered in 57% of PD patients who developed calciphylaxis. One-year mortality in PD patients who developed calciphylaxis was 71% despite multimodal treatment including sodium thiosulfate, hyperbaric oxygen, cinacalcet, and wound debridement. Conclusion: Calciphylaxis is a rare but frequently fatal condition in PD patients. Our study provides critical early insights into calciphylaxis incidence, risk factors, and prognosis in PD patients. Sample size and characteristics of patients included in our study limit generalizability to overall PD population and warrant examination in larger independent studies.

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Phosphate control in dialysis

Cited by 61 publications

References 88 publications

Effect of Patiromer on Urinary Ion Excretion in Healthy Adults

Effect of Patiromer on Urinary Ion Excretion in Healthy Adults

The Effect of Nutrition Education Program on Biochemical Parameters Among Patients With Chronic Kidney Disease Undergoing Hemodialysis

Calciphylaxis in peritoneal dialysis patients: a single center cohort study

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