Effect of chitosan chewing gum on reducing serum phosphorus in hemodialysis patients: a multi-center, randomized, double-blind, placebo-controlled trial

Akizawa, Tadao; Tsuruta, Yoshinari; Okada, Yoichi; Miyauchi, Yoshimasa; Suda, Akio; Kasahara, Hiroshi; Sasaki, Nobuhiro; Maeda, Yoshitaka; Suzuki, Takehiko; Matsui, Noriaki; Niwayama, Jun; Suzuki, Toshiaki; Hara, Hideaki; Asano, Yoshihide; Komemushi, Sadao; Fukagawa, Masafumi

doi:10.1186/1471-2369-15-98

Cited by 13 publications

(9 citation statements)

References 26 publications

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“…The chitosan-loaded chewing gum HS219 does not affect serum and salivary phosphorus levels in Japanese HD patients with hyperphosphatemia. These findings do not support previous findings that 20 mg of chitosan-loaded chewing gum reduces serum and salivary phosphorus levels [63].…”

Section: Salivary Phosphorus Binding Agentscontrasting

confidence: 70%

Contemporary management of phosphorus retention in chronic kidney disease: a review

Amiri

2015

Clin Exp Nephrol

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Hyperphosphatemia is the most common metabolic complications of end-stage kidney disease (ESKD). Large observational studies have identified hyperphosphatemia as an independent risk factor for cardiovascular disease and mortality in dialysis patients and subsequent studies found that subtle increases in serum phosphate levels even within the normal range are also associated with increased risk for death in predialysis and non-kidney disease population. On the basis of these results, current national practice guidelines advocate more aggressive treatment of hyperphosphatemia to lower serum phosphate targets than in the past . Treatment of hyperphosphatemia requires to strict management through dietary restriction, oral phosphate binders, and dialysis. Calcium-based phosphate binders have low cost and widespread use but cause vascular calcification and hypercalcemia. Non-calcium-based phosphate binders are effective but expensive. Bixalomer is a new Ca-free, metal-free, potent phosphate binder, non-hydrochloride, and non-absorptive polymer, which improves metabolic acidosis. FGF-23 appears as a promising target for novel therapeutic approaches to improve clinical outcomes of CKD patients. This review focuses on novel therapeutic approaches dealing with hyperphosphatemia in chronic kidney disease.

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Section: Salivary Phosphorus Binding Agentscontrasting

confidence: 70%

Contemporary management of phosphorus retention in chronic kidney disease: a review

Amiri

2015

Clin Exp Nephrol

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“…These results were in (9) who found that serum phosphate significantly decreased during the first weeks of chewing chitosan gum in ESRD patients and returned to baseline after discontinuing the chewing gum. Our results were not in agreement with Akizawa T et al,2014 (10) who found that chewing gum and expelling saliva does not affect serum and salivary phosphorus levels in Japanese HD patients with hyperphosphatemia. On the other hand, our study showed that group patients (CKD patients stage 3 or 4 who received calcium acetate and pilocarpine) had increased salivary urea, creatinine, and phosphorus levels when compared with control group (CKD patients stage 3 or 4 who received calcium acetate only) with p value <0,06 for all comparisons, and also had decreased serum urea, creatinine and phosphorus levels when compared with control group with p value <0,03 for all comparisons.…”

Section: Discussioncontrasting

confidence: 56%

Effects of Expelling of Induced Hypersalivation on Serum Phosphorus, Urea and Creatinine Levels in End Stage Renal Disease Patients

Abouelhassan

Abd-Elmenem²,

Thabet³

2017

IAM

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Introduction: Saliva has hundreds of components that may serve to detect systemic diseases or as evidence of exposure to various harmful substances, as well as provide biomarkers of health and disease status. Pilocarpine has effects on serum urea, creatinine and phosphorus in patients with chronic kidney disease (CKD) and patients with End Stage Renal Disease (ESRD) on hemodialysis. Pilocarpine is a parasympathomimetic drug used to induce hypersalivation. Parasympathetic stimulation leads to acetylcholine (ACh) release into the salivary acinar cells. ACh causes the salivary gland to release kallikrein, an enzyme that converts kininogen to lysyl-bradykinin. Lysylbradykinin acts upon blood vessels and capillaries of the salivary gland to generate vasodilation and increased capillary permeability respectively. The resulting increased blood flow to the acini allows production of more saliva. Aim of work: To determine the effects of expelling induced hyper salivation on serum Phosphorus, urea and creatinine levels in CKD and ESRD patients. Materials and Methods: It is a case control study which included 80 patients divided into Group A: 40 patients with End Stage Renal Disease on Hemodialysis for at least six months in Assiut University Hospital and Group B: 40 patients with Chronic Kidney Disease (stage 3,4) on conservative medical treatment. Both groups were complaining of hyperphosphatemia. Their ages ranged from 18 to 60 years old with mean age ± SD (51 ± 11), pilocarpine mouth washer (4% concentration, 5 ml pilocarpine which equals 13 mg, three times daily) is given for two months. Results: After pilocarpine intake; there was a decrease in serum phosphorus level in CKD patients (33%) than those with ESRD (30%). But there was a decrease in serum creatinine level in ESRD patients (23%) than those with CKD patients (15%). The two groups had the same percentage of decrease in blood urea level (40%). In salivary measures after pilocarpine intake; one hundred percent increase in phosphorus excretion in both group but patients with ESRD showed more creatinine excretion compared to patients with CKD (84% vs. 60%). CKD patients had more urea excretion in saliva versus to patients with ESRD (100% and 55%) respectively. Conclusion: Pilocarpine has a role in improving hyperphosphatemia in CKD patients and ESRD patients, also pilocarpine led to decrease in serum urea and creatinine levels so it can be used as an adjuvant therapy in CKD and ESRD patients.

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“…37 It is similar to sevelamer; however; it absorbs less water thus showing less swelling and higher fluidity than sevelamer. 16,17 In phase 3 studies conducted in Japan, bixalomer was shown to be as effective as sevelamer for the management of serum PO 4 levels with 72.2% of subjects achieving target PO 4 levels, between 3.5 and 6.0 mg/dL as compared with the sevelamer group, which only had 68% achieve those levels. Additionally, the percentage of GI adverse events was significantly lower in the bixalomer group with 29.1% reporting events versus 47.3% in the sevelamer group.…”

Section: Calcium-based Bindersmentioning

confidence: 99%

“…14,15 Bixalomer another nonmetal, nonabsorbable is available in Japan. 16,17 Velphoro Ò (sucroferric oxyhydroxide), a chewable, ironbased binder with no significant change on iron parameters, 18 and Auryxia Ò (ferric citrate) an iron-based binder with clinically and statistically significant increases in iron parameters. 19 Additionally, studies have looked into once daily dosing of sevelamer, the use of niacin/nicotinamide, and the use of a salivary phosphate-binding chewing gum to improve serum PO 4 levels.…”

mentioning

confidence: 99%

An Update on Phosphate Binders: A Dietitian's Perspective

Gutekunst¹

2016

Journal of Renal Nutrition

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Effect of chitosan chewing gum on reducing serum phosphorus in hemodialysis patients: a multi-center, randomized, double-blind, placebo-controlled trial

Cited by 13 publications

References 26 publications

Contemporary management of phosphorus retention in chronic kidney disease: a review

Contemporary management of phosphorus retention in chronic kidney disease: a review

Effects of Expelling of Induced Hypersalivation on Serum Phosphorus, Urea and Creatinine Levels in End Stage Renal Disease Patients

An Update on Phosphate Binders: A Dietitian's Perspective

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