Multidisciplinary Perspectives of Current Approaches and Clinical Gaps in the Management of Hyperphosphatemia

Int J Nephrol Renovasc Dis. 2021 Aug 6;14:301-311. doi: 10.2147/IJNRD.S318593. eCollection 2021.ABSTRACTPopulation-based studies have shown that most patients with advanced chronic kidney disease (CKD) do not have optimal phosphate levels. Meta-analyses suggest that there is a morbidity and mortality benefit associated with the lowering of serum phosphate levels. However, to date there is no conclusive evidence from randomized controlled trials (RCTs) that lowering serum phosphate levels reduces the risk of morbidity and mortality. However, hyperphosphatemia may pose a risk to patients and treatment should be considered. We therefore sought to conduct a multidisciplinary review to help guide clinical decision-making pending results of ongoing RCTs. Restricting dietary phosphate intake is frequently the first step in the management of hyperphosphatemia. Important considerations when proposing dietary restriction include the patient's socioeconomic status, lifestyle, dietary preferences, comorbidities, and nutritional status. While dietary phosphate restriction may be a valid strategy in certain patients, serum phosphate reductions achieved solely by limiting dietary intake are modest and should be considered in conjunction with other interventions. Conventional dialysis is also typically insufficient; however phosphate removal may be augmented by increased frequency or duration of dialysis, or through enhanced methods such as hemodiafiltration. Phosphate binders have been show...
Source: International Journal of Nephrology and Renovascular Disease - Category: Urology & Nephrology Authors: Source Type: research

Related Links:

Nefrologia. 2021 Jul-Aug;41(4):478-480. doi: 10.1016/j.nefro.2020.07.005. Epub 2020 Sep 29.NO ABSTRACTPMID:34629597 | PMC:PMC7522631 | DOI:10.1016/j.nefro.2020.07.005
Source: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia - Category: Urology & Nephrology Authors: Source Type: research
AbstractIntroductionInflammation in patients with ESRD undergoing HD is an increasing concern for physicians and has been related to increase the rates of morbidity and mortality. Interestingly, patients with ESRD in conventional HD have frequent infections and a suboptimal response to vaccines; this is probably related to an immune inflammatory disorder associated either with uremia and/or nutritional status. In addition to CRP, which seems to be the most important marker for the identification and control of inflammation in clinical practice, many other markers are also available for the evaluation of inflammatory state....
Source: QJM - Category: Internal Medicine Source Type: research
Mol Cell Biochem. 2021 Jul 29. doi: 10.1007/s11010-021-04225-y. Online ahead of print.ABSTRACTThe aim of our study was to investigate the effects of one-month consumption of polyphenol-rich standardized Aronia melanocarpa extract (SAE) on redox status in anemic hemodialysis patients. The study included 30 patients (Hb 3 months;> 3 times week). Patients were treated with commercially available SAE in a dose of 30 ml/day, for 30 days. After finishing the treatment blood samples were taken to evaluate the effects of SAE on redox status. Several parameters of anemia and inflammation were also followed. After the completion ...
Source: Molecular and Cellular Biochemistry - Category: Biochemistry Authors: Source Type: research
ConclusionsThe present meta-analysis demonstrated that non-calcium-based phosphate binders including sevelamer, lanthanum, and iron-based phosphate binders, iron supplements, calcimimetics, hemoperfusion, and preservation of RRF could effectively reduce FGF23 in CKD patients.
Source: International Urology and Nephrology - Category: Urology & Nephrology Source Type: research
Due to a critical shortage of available kidney grafts, most patients with Stage 5 Chronic Kidney Disease (CKD5) require bridging dialysis support. It remains unclear whether treatment by different dialysis mod...
Source: BMC Nephrology - Category: Urology & Nephrology Authors: Tags: Research article Source Type: research
CONCLUSIONS: The present meta-analysis demonstrated that prebiotics, synbiotics, and AST-120 can effectively reduce both serum indoxyl sulfate and p-cresyl sulfate in CKD patients when compared with placebo. Preservation of RRF was associated with lower serum indoxyl sulfate and p-cresyl sulfate levels. The effect of biotic supplements was detected only in dialysis patients. For non-dialysis CKD patients, the results were limited due to the small number of studies. Further studies are needed to determine the efficacy in these populations. PMID: 33484425 [PubMed - as supplied by publisher]
Source: Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: J Nephrol Source Type: research
Authors: Nagata D, Yoshizawa H Abstract Although there are many uremic substances in the body, the most studied and well-known molecule that predominantly binds to plasma proteins is indoxyl sulfate (IS). Many research groups have reported IS to have toxic effects on the kidney and cardiovascular system. It is difficult to remove IS with regular hemodialysis or hemodiafiltration. On the other hand, AST-120 has the capacity to bind to indole, which is a precursor of IS in the intestinal tract and excrete it in feces. IS production in the liver is efficiently suppressed by AST-120 administration. However, large-scale...
Source: International Journal of Nephrology and Renovascular Disease - Category: Urology & Nephrology Tags: Int J Nephrol Renovasc Dis Source Type: research
Authors: Xing X, Yang Y, Shi J, Cheng A, Wang Y, Xu G, He F PMID: 33158603 [PubMed - as supplied by publisher]
Source: Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia - Category: Urology & Nephrology Tags: Nefrologia Source Type: research
ConclusionsKidney function impairment increased the AUC of roxadustat and its metabolites. TheCmax andt1/2 of roxadustat were comparable among groups. Roxadustat and its metabolites were not cleared by HD/HDF.Clinical Trials Registration Number:  NCT02965040.
Source: European Journal of Drug Metabolism and Pharmacokinetics - Category: Drugs & Pharmacology Source Type: research
Abstract The total number of end-stage kidney disease patients treated with dialysis in 2019 in Kuwait was 2230, with a 6% increase from the year before. Dialysis prevalence was 465 per million population (PMP) and dialysis incidence was100 PMP. Kuwaiti nationals represented 70% of the dialysis population and males represented 52%. Of the same population, 59% had diabetes. Hepatitis C virus affected
Source: Saudi Journal of Kidney Diseases and Transplantation - Category: Urology & Nephrology Authors: Tags: Saudi J Kidney Dis Transpl Source Type: research
More News: Chronic Kidney Disease | Dialysis | Diets | Hemodiafiltration | Jordan Health | Middle East Health | Nutrition | Study | Urology & Nephrology