Association of Circulating Fibroblast Growth Factor-23 with Renal Phosphate Excretion among Hemodialysis Patients with Residual Renal Function

Wang, Mengjing; Li, You; Li, Haiming; Yan, Lin; Zhang, Zhijie; Hao, Chuan‐Ming; Chen, Jing

doi:10.2215/cjn.00230112

Cited by 22 publications

(27 citation statements)

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“…There are several potential explanations for this finding. First, serum phosphorus level is highly variable among subjects with kidney disease (Kestenbaum et al, 2005; Wang et al, 2013). A longitudinal study with several assessments over time may minimize the effect of this variation, and inform the achievement of phosphorus control as well as factors related to sustained control over time, similar to studies of diabetes control.…”

Section: Discussionmentioning

confidence: 99%

Health care providers’ support of patients’ autonomy, phosphate medication adherence, race and gender in end stage renal disease

Umeukeje¹,

Merighi²,

Browne³

et al. 2016

J Behav Med

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This study was designed to assess dialysis subjects’ perceived autonomy support association with phosphate binder medication adherence, race and gender. A multi-site cross-sectional study was conducted among 377 dialysis subjects. The Health Care Climate (HCC) Questionnaire assessed subjects’ perception of their providers’ autonomy support for phosphate binder use, and adherence was assessed by the self-reported Morisky Medication Adherence Scale (MMAS). Serum phosphorus was obtained from the medical record. Regression models were used to examine independent factors of medication adherence, serum phosphorus, and differences by race and gender. Non-white HCC scores were consistently lower compared with white subjects’ scores. No differences were observed by gender. Reported phosphate binder adherence was associated with HCC score, and also with phosphorus control. No significant association was found between HCC score and serum phosphorus. Autonomy support, especially in non-white end stage renal disease subjects, may be an appropriate target for culturally informed strategies to optimize mineral bone health.

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Section: Discussionmentioning

confidence: 99%

Health care providers’ support of patients’ autonomy, phosphate medication adherence, race and gender in end stage renal disease

Umeukeje¹,

Merighi²,

Browne³

et al. 2016

J Behav Med

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“…Table 3 shows that the percentage of patients with RKF (urine volume ≥200 ml/day) at the time of enrollment in September 2012 [34] was significantly higher in Group A treated with fewer initial HD frequency compared to Group B treated with regular thrice-weekly HD. The estimated residual GFR in patients with RKF was also greater in Group A than that of Group B, even though the daily urine output did not show any significant changes between the two groups.…”

Section: Resultsmentioning

confidence: 99%

Association of Initial Twice-Weekly Hemodialysis Treatment with Preservation of Residual Kidney Function in ESRD Patients

et al. 2014

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Background: Residual kidney function (RKF) has consistently been a predictor of greater survival in maintenance hemodialysis (MHD) patients. The relationship between hemodialysis (HD) treatment frequency and RKF preservation has not been well examined. We hypothesized that initial twice-weekly HD helps in maintaining a longer RKF. Methods: In a dialysis center in Shanghai, 168 ESRD patients were screened and finally 85 patients were identified for this main cohort study. We first examined these 85 MHD patients; 30 of them were initiated with twice-weekly HD for 6 months or longer and 55 patients were started and maintained on thrice-weekly HD treatment. Then a subcohort study in 48 incident MHD patients was implemented to assess the independent risk factors responsible for RKF decline during the first year of HD therapy. Multivariate logistic regression analysis was then employed to examine the odds ratio of RKF loss. Results: The main cohort study showed that the clinical outcomes were almost the same between the two groups in 85 patients, but the percent of patients with RKF loss was significantly lower in the twice-weekly group compared with the thrice-weekly group, especially during the first year of HD initiation. In the 48 incident MHD patients, we found no significant differences between the two groups except for variations in the HD frequency, weekly Kt/V. The multivariate analysis showed that factors such as the male gender, HD frequency, URR and intradialytic hypotension episode were associated with RKF loss, and the odds ratio of RKF loss for each additional HD treatment per week was 7.2. Conclusion: Twice-weekly HD during the first year of dialysis therapy appears to be associated with better RKF preservation.

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“…16 Higher RKF may be related to greater survival through different mechanisms, including better fluid and salt removal, more effective phosphorus excretion, better middle molecule clearance, more endogenous vitamin D and erythropoietin production, reduced left ventricular hypertrophy, and less inflammation. 8–11, 17 Indeed a survival advantage of diuretic therapy in dialysis patients may be related to RKF. 18 …”

Section: Residual Kidney Functionmentioning

confidence: 99%

Twice-Weekly and Incremental Hemodialysis Treatment for Initiation of Kidney Replacement Therapy

Kalantar-Zadeh

Unruh

Zager

et al. 2014

American Journal of Kidney Diseases

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156

157

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Mortality is highest in the first months of maintenance hemodialysis (HD). In many Western countries, patients who transition to kidney replacement therapy usually begin thrice-weekly HD regardless of their level of residual kidney function (RKF). RKF is a major predictor of survival. RKF may decline more rapidly with more thrice-weekly HD treatments, is associated with a reduced need for dialytic solute clearance, and is an important factor in the prescription of peritoneal dialysis. In this paper we review the concept of incremental HD, in which weekly dialysis dose, in particular HD treatment frequency, is based on a variety of clinical factors such as RKF (including urine output >0.5 L/day), volume status, cardiovascular symptoms, body size, potassium and phosphorus levels, nutritional status, hemoglobin, comorbid conditions, hospitalizations, and health related quality of life. These ten clinical criteria may identify which patients might benefit from beginning maintenance HD twice-weekly. Periodic monitoring of these criteria will determine the timing for increasing dialysis dose and frequency. We recognize that twice-weekly HD represents a major paradigm shift for many clinicians and jurisdictions. Therefore, we propose conducting randomized controlled trials of twice-weekly vs. thrice-weekly HD to assess the potential of twice-weekly HD to improve survival and health related quality of life while simultaneously reducing costs, protecting fragile vascular accesses, and optimizing resource use. Such incremental and individualized HD therapy may prove to be the most appropriate approach for transitioning to dialytic therapy.

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Association of Circulating Fibroblast Growth Factor-23 with Renal Phosphate Excretion among Hemodialysis Patients with Residual Renal Function

Cited by 22 publications

References 50 publications

Health care providers’ support of patients’ autonomy, phosphate medication adherence, race and gender in end stage renal disease

Health care providers’ support of patients’ autonomy, phosphate medication adherence, race and gender in end stage renal disease

Association of Initial Twice-Weekly Hemodialysis Treatment with Preservation of Residual Kidney Function in ESRD Patients

Twice-Weekly and Incremental Hemodialysis Treatment for Initiation of Kidney Replacement Therapy

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