Hyperphosphatemia Management in Patients with Chronic Kidney Disease

Shaman, Ahmed M.; Kowalski, Stefan R.

doi:10.1016/j.jsps.2015.01.009

Cited by 97 publications

(90 citation statements)

References 140 publications

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“…Hypocalcemia is mainly due to decreased absorption from intestine secondary to inadequate vitamin D and deposition of calcium and phosphorus product in bone secondary to hyperphosphatemia in CKD. 22 Hyperphosphatemia is the independent predictor of increased cardiovascular mortality 23 . High prevalence of hyperphosphatemia in pre-dialysis CKD has been reported from different parts of the world with 69.4% in Nigeria 8 and 53.7% to 64.1% in India 18 .…”

Section: Discussionmentioning

confidence: 99%

Estimation of Serum Vitamin D, Calcium and Phosphorus in Chronic Kidney Disease

Rajbhandari

Agrawal

Baral

et al. 2017

Med. J. Shree Birendra Hosp.

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h y p o c a l c a e m i a a n d c o m p e n s a t o r y hyperparathyroidism. But with advancing disease, the compensatory mechanism can no more maintain the mineral homeostasis and biochemical a b n o r m a l i t i e s l i k e h y p e r p h o s p h a t e m i a , hypocalcaemia and hyperparathyroidism become obvious at stage 4 CKD. 3,4 Besides, decreased kidney function, lack of adequate storage of vitamin D (25, OH vitamin D / calcidiol) is responsible for decreased calcitriol synthesis and its consequences in CKD. 5 Studies have shown vitamin D deficiencies (20-29 ng/ml) and insufficiency (<20 ng/ml) in CKD, both in pre dialysis and maintenance hemodialysis patients, MJSBH Vol 16 Issue 1 Jan-June 2017 30ABSTRACT Introduction: Abnormalities in mineral metabolism are invariable with progressive deterioration of kidney function in chronic kidney disease (CKD). These abnormalities are documented in CKD on dialysis in our population but not on pre dialysis. So, present study aims to estimate serum vitamin D, calcium and phosphorus in CKD stage 3-5ND. Methods: It was a cross sectional study of established new CKD patients not on dialysis, vitamin D, calcium, phosphate binders and corticosteroids therapy. Blood sample was drawn for estimation of serum vitamin D, creatinine, calcium, phosphorus and albumin and CKD staging done by KDIGO (2012) criteria. SPSS software version 19 was used for data analysis and chi-squared and ANOVA test was applied as the test of significance. Results: Sixty six (51 male and 15 female) CKD patients with a mean age of 54.3±14.8 years were studied. Hypovitaminosis D (<30 ng/ml) was present in 84.8%, with deficiency (<20 ng/ml) in 50% and insufficiency (20-30) ng/ml in 34.8%. Other abnormalities observed were hypocalcemia (60.6%), hypercalcemia (1.5%) and hyperphosphatemia (63.6%) with no difference of corrected calcium, significant difference of serum phosphorus (p<0.001) with hyperphosphatemia in stage 4 and 5 CKD and vitamin D insufficiency in stage 3b, deficiency in stage 3a, 4 and 5 CKD. There was no correlation of serum vitamin D with calcium and phosphorus in different stages of CKD. Conclusion: Present study concludes that hypovitaminosis D, hypocalcemia and hyperphosphatemia is common in our pre-dialysis CKD patients and serum phosphorus raises more with reduction of GFR.

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Section: Discussionmentioning

confidence: 99%

Estimation of Serum Vitamin D, Calcium and Phosphorus in Chronic Kidney Disease

Rajbhandari

Agrawal

Baral

et al. 2017

Med. J. Shree Birendra Hosp.

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“…Hyperphosphatemia in end-stage renal disease (ESRD) is a common and serious biochemical abnormality linked to vascular calcification, renal osteodystrophy and secondary hyperparathyroidism [1][2][3][4]. The abnormality is significantly associated with increased mortality among ESRD patients on hemodialysis [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Hyperphosphatemia in End Stage Renal Disease: Prevalence and Patients Characteristics of Multiethnic Population of United Arab Emirates

Rabbani

Sathvik

Rao

et al. 2017

Int J Pharm Pharm Sci

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Objective: Hyperphosphatemia is significantly associated with increased mortality among end-stage renal disease (ESRD) patients on hemodialysis.There is a paucity of data on hyperphosphatemia in ESRD patients of the multiethnic population of United Arab Emirates (UAE). The study aimed to investigate the prevalence and characteristics of hyperphosphatemia in ESRD patients of the multiethnic population of UAE undergoing maintenance hemodialysis. Methods:Adults ESRD patients undergoing maintenance hemodialysis for more than six months at the study site were included. Demographic, clinical and biological data of the patients were collected. Patient characteristics were compared as per the serum phosphate level, between patients with or without hyperphosphatemia. Univariate and multivariate logistic regression analyses were carried out to identify the predictors of hyperphosphatemia.Results: Hyperphosphatemia was present in 73.8% of the study population, while 31.3% presented with the high calcium-phosphate product. Univariate logistic analysis revealed that hyperphosphatemia was inversely correlated with age, haemoglobin, serum calcium, and hypertensive nephropathy as the cause of renal disease, and positively correlated with female gender, expatriate status, body mass index (BMI), a higher number of comorbidities, calcium-phosphate product and parathyroid hormone (PTH). Multivariate logistic regression model revealed that only age, BMI, haemoglobin and PTH independently correlated with hyperphosphatemia. Conclusion:We report a high prevalence of hyperphosphatemia in multiethnic study population undergoing maintenance hemodialysis at a secondary care hospital in UAE. In this study population, only age, BMI, hemoglobin and PTH were identified as independent predictors of hyperphosphatemia.

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“…Ca Alb was calculated as: if serum albumin concentration was <40 g/L, Ca Alb was calculated as: Ca Alb = serum calcium (mmol/L) + 0.02× (40‐serum albumin (g/L)); if serum albumin was ≥40 g/L, then corrected calcium is equal to serum calcium . According to the recommendation of the Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines, patients were stratified into different categories with the following criteria: Phos (<1.13, 1.13–1.78, >1.78 mmol/L), Ca Alb (<2.10, 2.10–2.37, and > 2.37 mmol/L), and Ca × P product (<4.4 mmol 2 /L 2 and ≥ 4.4 mmol 2 /L 2 ), respectively …”

Section: Methodsmentioning

confidence: 99%

Associations between serum mineral metabolism parameters and mortality in patients on peritoneal dialysis

Huang

et al. 2019

Nephrology

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Aim Disturbances in mineral metabolism markers are common in patients with chronic kidney disease but there is no consensus on the association between these markers and clinical outcomes. This study investigated associations between mineral metabolism parameters and mortality in Chinese peritoneal dialysis (PD) patients. Methods This was a single‐centre retrospective cohort study. Incident PD patients between 1 January 2006 and 31 December 2013 with baseline phosphate, albumin‐corrected calcium, and calcium‐phosphate product data were enrolled. Associations between these parameters and all‐cause and cardiovascular mortality were assessed using multivariable‐adjusted Cox models. Results Of 1662 patients (mean age: 47.4 ± 15.3 years), 59.3% were male and 23.8% had diabetes. Over a median 38.1 month (interquartile range: 21.3–59.7 months) follow‐up period, 382 (23.0%) patients died. After adjusting for confounders, the higher serum phosphate level (>1.78 mmol/L) and calcium‐phosphate product level (≥4.4 mmol2/L2) were significantly associated with an increased risk for all‐cause mortality (hazards ratio (HR) = 1.818, 95% CI = 1.379–2.396 and HR = 1.735, 95% CI = 1.261–2.386) and cardiovascular mortality (HR = 2.069, 95% CI = 1.428–2.998 and HR = 2.175, 95% CI = 1.450–3.262), respectively. While each 1 mmol/L higher baseline albumin‐corrected calcium level was associated with an 14.3% (95% CI = 0.749–0.981) lower risk for all‐cause mortality after adjusting for potential confounders. Conclusion Abnormalities in mineral metabolism markers, particularly higher serum phosphate and calcium‐phosphate product levels, at the commencement of PD were independently associated with increased all‐cause and cardiovascular mortality in this cohort of PD patients.

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Hyperphosphatemia Management in Patients with Chronic Kidney Disease

Cited by 97 publications

References 140 publications

Estimation of Serum Vitamin D, Calcium and Phosphorus in Chronic Kidney Disease

Estimation of Serum Vitamin D, Calcium and Phosphorus in Chronic Kidney Disease

Hyperphosphatemia in End Stage Renal Disease: Prevalence and Patients Characteristics of Multiethnic Population of United Arab Emirates

Associations between serum mineral metabolism parameters and mortality in patients on peritoneal dialysis

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