The Phosphate Content of Prescription Medication: A New Consideration

Sherman, Richard A.; Ravella, Supriya; Kapoian, Toros

doi:10.1177/2168479015592194

Cited by 13 publications

(19 citation statements)

References 11 publications

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“…While the DIP and DABP measures, for the most part, reflect dietary phosphorus intake, it has been previously shown that phosphate may be included in the excipients of select medications [9]. We did not analyze the phosphate content of the medications taken by our patients, and a high value for DIP or DABP in some patients might have been due not only to consumption of a high phosphorus diet but also to ingestion of phosphorus from medications.…”

Section: Discussionmentioning

confidence: 99%

Modeled Daily Ingested, Absorbed and Bound Phosphorus: New Measures of Mineral Balance in Hemodialysis Patients

Kapoian

Khalil

O'Mara³

et al. 2019

Am J Nephrol

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Background: Control of predialysis serum phosphorus in hemodialysis patients is challenging. We explored the utility of a novel kinetic phosphorus modeling program. Methods: As part of a quality assurance program, urea kinetic modeling results were combined with those from phosphorus kinetic modeling to compute modeled daily ingested phosphorus (DIP) and components making up this metric, including absorbed, bound, and nonabsorbed, nonbound phosphorus. Results: In 182 hemodialysis patients, DIP averaged 1,089 ± 348 mg/day in men and 934 ± 292 in women (p < 0.002) and correlated substantially with body weight. DIP/kg bodyweight (12.8 ± 3.40 mg/kg) was not significantly different between the sexes. Prescribed equivalent binder dose (EBD) was 4.98 ± 3.61 and 4.53 ± 3.02 g/day in men and women, respectively (p NS). Protein catabolic rate (PCR) was significantly higher in men (64.4 ± 18) g/day vs. women (48.2 ± 15.6, p < 0.001), and the DIP/PCR ratio was 17.4 ± 4.81 in men vs. 20.1 ± 5.76 in women (p < 0.001). Presence of residual kidney function was associated with a lower prescribed EBD dose (4.08 ± 2.62 vs. 5.38 ± 3.81 g/day, p < 0.01). Self-reported poor binder compliance was associated with higher DIP or DIP/kg as well as higher prescribed EBD. In anuric patients, DIP/kg was increased in patients consuming diets with high phosphate additive content and those reporting poor compliance with the prescribed dose of phosphate binders. Conclusions: The combination of urea kinetic and phosphorus modeling can be used to estimate measures related to phosphorus intake. High DIP/PCR or DIP/kg body weight values in anuric patients suggest consumption of a diet high in phosphorus additives or noncompliance with the prescribed amount of phosphorus binders.

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Section: Discussionmentioning

confidence: 99%

Modeled Daily Ingested, Absorbed and Bound Phosphorus: New Measures of Mineral Balance in Hemodialysis Patients

Kapoian

Khalil

O'Mara³

et al. 2019

Am J Nephrol

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“…27 Examples of drugs taken by ESRD patients that contain phosphorus are central nervous system medications such as paroxetine (111.5 mg phosphate per 40 mg tablet), codeine, and oxycodone; CV medications including amlodipine (120 mg phosphate per 10 mg tablet) and lisinopril (32.6 mg phosphate per 10 mg tablet); and the diabetic drug sitagliptin (110 mg phosphate per 100 mg tablet). 27,37,38 However, the level of phosphorus can vary between different formulations of the same drug, which underscores the difficulty in controlling medicinal phosphorus intake. 39 Patients should be encouraged to consume foods with the least amount of inorganic phosphate, low phosphorus-to-protein ratios, and adequate protein content.…”

Section: Phosphorus Control In Chronic Kidney Diseasementioning

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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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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“…The tremendous inter-patient phosphate absorption variability has been highlighted previously [ 14 ]. It is also important to note that many medications contain phosphate and can serve as a significant source of hidden but very bioavailable phosphate [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…This implies that patients with diabetes mellitus treated with calcitriol might be expected to have the highest serum phosphate levels. Lastly, several medications used for the treatment of diabetes mellitus include highly bioavailable inorganic phosphate as an additive which is not captured in the diet diaries but would appear as increased gastrointestinal absorption of phosphate and increase phosphate excretion [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Diabetes Mellitus and Younger Age Are Risk Factors for Hyperphosphatemia in Peritoneal Dialysis Patients

et al. 2017

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Hyperphosphatemia has been associated with adverse outcomes in patients with end stage kidney disease (ESKD). The purpose of this study was to determine risk factors for hyperphosphatemia in ESKD patients treated with peritoneal dialysis (PD). This information will be used to develop a patient specific phosphate binder application to facilitate patient self-management of serum phosphate. Adult PD patients documented their food, beverage, and phosphate binder intake for three days using a dietitian developed food journal. Phosphate content of meals was calculated using the ESHA Food Processor SQL Software (ESHA Research, Salem, UT, USA). Clinic biochemistry tests and an adequacy assessment (Baxter Adequest program) were done. Univariate logistic regression was used to determine predictors of serum phosphate >1.78 mmol/L. A multivariable logistic regression model was then fit including those variables that achieved a significance level of p < 0.20 in univariate analyses. Sixty patients (38 men, 22 women) completed the protocol; they were 60 ± 17 years old, 50% had a history of diabetes mellitus (DM) and 33% had hyperphosphatemia (PO4 > 1.78 mmol/L). In univariate analysis, the variables associated with an increased risk of hyperphosphatemia with a p-value < 0.2 were male gender (p = 0.13), younger age (0.07), presence of DM (0.005), higher dose of calcium carbonate (0.08), higher parathyroid serum concentration (0.08), lower phosphate intake (0.03), lower measured glomerular filtration rate (0.15), higher phosphate excretion (0.11), and a higher body mass index (0.15). After multivariable logistic regression analysis, younger age (odds ratio (OR) 0.023 per decade, 95% confidence interval (CI) 0.00065 to 0.455; p = 0.012), presence of diabetes (OR 11.40, 95 CI 2.82 to 61.55; p = 0.0003), and measured GFR (OR 0.052 per mL/min decrease; 95% CI 0.0025 to 0.66) were associated with hyperphosphatemia. Our results support that younger age and diabetes mellitus are significant risk factors for hyperphosphatemia. These findings warrant further investigation to determine the potential mechanisms that predispose younger patients and those with DM to hyperphosphatemia.

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The Phosphate Content of Prescription Medication: A New Consideration

Abstract: Commonly prescribed drugs may contain clinically important levels of phosphate.

Cited by 13 publications

References 11 publications

Modeled Daily Ingested, Absorbed and Bound Phosphorus: New Measures of Mineral Balance in Hemodialysis Patients

Modeled Daily Ingested, Absorbed and Bound Phosphorus: New Measures of Mineral Balance in Hemodialysis Patients

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

Diabetes Mellitus and Younger Age Are Risk Factors for Hyperphosphatemia in Peritoneal Dialysis Patients

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