The extra-phosphate intestinal load from medications: is it a real concern?

Cupisti, Adamasco; Moriconi, Diego; Verde, Francesco; Marchini, M; Egidi, Maria Francesca

doi:10.1007/s40620-016-0306-5

Cited by 6 publications

(7 citation statements)

References 10 publications

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“…This is further complicated by other hidden sources of phosphorus in foods and medications (see Box 3). [23][24][25][26][27] In the United States, the recommended daily allowance of phosphorus for adults is 900 mg/day. In a typical diet, the phosphorus content is generally proportional to the amount of protein, and the 3 main sources of phosphorus are proteins, dairy products, and cereals and grains.…”

Section: Box 2 Novel Paradigm For Hyperphosphatemia Management In Ckmentioning

confidence: 99%

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Management of Hyperphosphatemia in End-Stage Renal Disease: A New Paradigm

Rastogi

Bhatt

Rossetti

et al. 2021

Journal of Renal Nutrition

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Bone and mineral metabolism becomes dysregulated with progression of chronic kidney disease (CKD), and increasing levels of parathyroid hormone serve as an adaptive response to maintain normal phosphorus and calcium levels. In end-stage renal disease, this response becomes maladaptive and high levels of phosphorus may occur. We summarize strategies to control hyperphosphatemia based on a systematic literature review of clinical trial and real-world observational data on phosphorus control in hemodialysis patients with CKD-mineral bone disorder (CKD-MBD). These studies suggest that current management options (diet and lifestyle changes; regular dialysis treatment; and use of phosphate binders, vitamin D, calcimimetics) have their own benefits and limitations with variable clinical outcomes. A more integrated approach to phosphorus control in dialysis patients may be necessary, incorporating measurement of multiple biomarkers of CKD-MBD pathophysiology (calcium, phosphorus, and parathyroid hormone) and correlation between diet adjustments and CKD-MBD drugs, which may facilitate improved patient management.

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Section: Box 2 Novel Paradigm For Hyperphosphatemia Management In Ckmentioning

confidence: 99%

“…More than 10% of drug formulations contain phosphorus, which can significantly contribute to the daily phosphorus intake in patients taking multiple medications simultaneously. 26,27 Common medications high in phosphorus include: 1. Paroxetine (antidepressant) 2.…”

Section: Box 3 Hidden Sources Of Phosphorusmentioning

confidence: 99%

Management of Hyperphosphatemia in End-Stage Renal Disease: A New Paradigm

Rastogi

Bhatt

Rossetti

et al. 2021

Journal of Renal Nutrition

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“…Furthermore, recent studies have shown that the current food tables do not take additives into account, and that phosphate and potassium content of processed foods may be significantly higher. Moreover, added phosphate or potassium are rapidly bioavailable and potentially more toxic [16][17][18][19][20].…”

Section: Lipidsmentioning

confidence: 99%

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

et al. 2020

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Dialysis and nutrition are two sides of the same coin—dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.

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“…It is mostly used as a pharmaceutical excipient, which in most cases is reported on the packaging label without the precise concentration 33 . Phosphates as excipients are most commonly used as diluents, buffers to prevent pH fluctuations, and provide the required density for the preparation, thereby facilitating appropriate route of administration 32,36 . Although excipients are often considered as pharmacologically inert ingredients, they could also have iatrogenic effects as shown by diethylene glycol in sulfanilamide, which caused acute kidney injury, killing more than 100 people in the US 37 .…”

Section: Phosphorus Content In Ckd Medicationmentioning

confidence: 99%

“…Commonly used drugs for long-term oral administration in patients with CKD alleviate comorbidities related to CV system and central nervous system (CNS). The different medications include antihypertensives, anticoagulants, immunosuppressants, hypoglycemic agents, lipid-lowering drugs, analgesics, antihistamines, antidepressants, anti-gout drugs, and gastrointestinal drugs 35,36 . A potential confounder in estimating the medicinal phosphorus content is the wide variation observed with different formulations of the same drug from different manufactures, which has been highlighted in previous studies 31,35 .…”

Section: Phosphorus Content In Ckd Medicationmentioning

confidence: 99%

The role of phosphate-containing medications and low dietary phosphorus-protein ratio in reducing intestinal phosphorus load in patients with chronic kidney disease

Wang

Han

et al. 2019

Nutr. Diabetes

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Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication in patients experiencing end-stage renal disease (ESRD). It includes abnormalities in bone and mineral metabolism and vascular calcification. Hyperphosphatemia is a major risk factor leading to morbidity and mortality in patients with chronic kidney disease. Increased mortality has been observed in patients with ESRD, with serum phosphorus levels of >5.5 mg/dL. Therefore, control of hyperphosphatemia is a major therapeutic goal in the prevention and treatment of CKD-MBD. The treatment of hyperphosphatemia includes decreasing intestinal phosphorus load and increasing renal phosphorus removal. Decreasing the intestinal load of phosphorus plays a major role in the prevention and treatment of CKD-MBD. Among the dietary sources of phosphorus, some of the commonly prescribed medications have also been reported to contain phosphorus. However, drugs are often ignored even though they act as a potential source of phosphorus. Similarly, although proteins are the major source of dietary phosphorus, reducing protein intake can increase mortality in patients with CKD. Recently, the importance of phosphorus/protein ratio in food have been reported to be a sensitive marker for controlling dietary intake of phosphorus. This review summarizes the progress in the research on phosphate content in drugs as an excipient and the various aspects of dietary management of hyperphosphatemia in patients with CKD, with special emphasis on dietary restriction of phosphorus with low dietary phosphate/protein ratio.

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The extra-phosphate intestinal load from medications: is it a real concern?

Cited by 6 publications

References 10 publications

Management of Hyperphosphatemia in End-Stage Renal Disease: A New Paradigm

Management of Hyperphosphatemia in End-Stage Renal Disease: A New Paradigm

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

The role of phosphate-containing medications and low dietary phosphorus-protein ratio in reducing intestinal phosphorus load in patients with chronic kidney disease

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