Phosphate-Containing Prescription Medications Contribute to the Daily Phosphate Intake in a Third of Hemodialysis Patients

Nelson, Seana Ml; Sarabia, Samantha; Christilaw, Erin; Ward, Emilie; Lynch, Stephanie; Adams, Michael; Holden, Rachel M.

doi:10.1053/j.jrn.2016.09.007

Cited by 29 publications

(29 citation statements)

References 18 publications

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“…3 Data from several studies have highlighted the challenge of regulating serum levels as this is influenced by several factors such as diet composition, food additives, phosphate binder use and medication adherence, phosphate-containing prescription medications, and CKD-MBD treatments. 17,39,42,[67][68][69] Whereas some studies have raised a potential link of high concentrations of serum phosphate with mortality in patients with CKD stage 5D, [70][71][72]76,77,81,82 other studies have not shown this association. 19,78 As such, the requirement to maintain or lower phosphate levels to normal range has been eliminated in this patient population.…”

Section: Phosphate Managementmentioning

confidence: 99%

“…80 This highlights the importance of awareness of the presence or absence of additives in foods consumed by patients and perhaps counselling toward consumption of food from raw, natural, or unprocessed/ least processed compared to ready-to-eat highly processed foods. Furthermore, a recent study 69 reported that phosphate-containing medications can meaningfully contribute to the daily phosphate load, with burden differing based on local dispensing patterns. These new findings highlight the need for providing individualized recommendations that take into account phosphate sources.…”

Section: Phosphate Managementmentioning

confidence: 99%

See 1 more Smart Citation

Overview of the 2017 KDIGO CKD-MBD Update: Practice Implications for Adult Hemodialysis Patients

Beto

Bhatt

Gerbeling³

et al. 2019

Journal of Renal Nutrition

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Renal dietitians play a pivotal role in the ongoing management of chronic kidney disease in patients on hemodialysis. Awareness of changes to clinical practice guidelines that may impact laboratory parameters associated with chronic kidney disease-mineral and bone disorder is important for optimal patient care. In this article, the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update recommendations related to the treatment of secondary hyperparathyroidism in adults on hemodialysis are reviewed and treatment implications for renal dietitians discussed. Specific attention is given to the integration of updated recommendations such as the use of calcimimetics as part of a combination approach to the existing treatment paradigm. Renal dietitians can directly apply the updated clinical recommendations in the evaluation of diet composition; food additives; medication adherence challenges with phosphate binder type and use and serial monitoring of phosphorus, calcium, and parathyroid hormone levels to inform clinical decisions on treatment options for patients.

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Section: Phosphate Managementmentioning

confidence: 99%

Section: Phosphate Managementmentioning

confidence: 99%

Overview of the 2017 KDIGO CKD-MBD Update: Practice Implications for Adult Hemodialysis Patients

Beto

Bhatt

Gerbeling³

et al. 2019

Journal of Renal Nutrition

View full text Add to dashboard Cite

show abstract

“…Up until recently, the phosphate burden from these patients’ medications was unquantified. Nelson et al (74) evaluated the phosphate content of medications prescribed in hemodialysis patients with advanced CKD. 11% of drug formulations prescribed in the 101 hemodialysis patients in the study contained phosphate, and 30% of patients were taking at least one of these medications.…”

Section: Special Considerations For Dietary Phosphorus In Ckd-mbdmentioning

confidence: 99%

Effects of Excessive Dietary Phosphorus Intake on Bone Health

Vorland

Stremke

Moorthi

et al. 2017

Curr Osteoporos Rep

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Purpose of Review The purpose of this review is to provide an overview of dietary phosphorus, its sources, recommended intakes, and its absorption and metabolism in health and in chronic kidney disease, and to discuss recent findings in this area with a focus on the effects of inorganic phosphate additives in bone health. Recent Findings Recent findings show that increasing dietary phosphorus through inorganic phosphate additives has detrimental effects on bone and mineral metabolism in humans and animals. There is new data supporting an educational intervention to limit phosphate additives in patients with chronic kidney disease to control serum phosphate. Summary The average intake of phosphorus in the US well-above the recommended dietary allowance. Inorganic phosphate additives, which are absorbed at a high rate, account for a substantial and likely underestimated portion of this excessive intake. These additives have negative effects on bone metabolism, and present a prime opportunity to lower total phosphorus intake in the U.S. Further evidence is needed to confirm whether lowering dietary phosphorus intake would have beneficial effects to improve fracture risk.

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“…Processed foods with significant amounts of added inorganic P include meat, dairy, and bakery products, as well as a growing number of drinks such as colas and some flavored drinks, bottled water, malted drinks and sterilized, ultra-heat treated, and thickened or powdered milks [31,32] (Table 4). In addition, inorganic phosphates are added to several medications, such as antacids and many anti-hypertensive medications, as an excipient that aids in dispersion of the active drug ingredient once ingested [33,34]; these can vary between manufacturers and across different formulations of the same medication. The P load from medications can make a meaningful contribution to the daily P intake, and thus should be reviewed carefully, particularly in patients receiving antihypertensive medications.…”

Section: Dietary Sources Of Calciummentioning

confidence: 99%

The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis—clinical practice recommendation from the Pediatric Renal Nutrition Taskforce

et al. 2019

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In children with chronic kidney disease (CKD), optimal control of bone and mineral homeostasis is essential, not only for the prevention of debilitating skeletal complications and achieving adequate growth but also for preventing vascular calcification and cardiovascular disease. Complications of mineral bone disease (MBD) are common and contribute to the high morbidity and mortality seen in children with CKD. Although several studies describe the prevalence of abnormal calcium, phosphate, parathyroid hormone, and vitamin D levels as well as associated clinical and radiological complications and their medical management, little is known about the dietary requirements and management of calcium (Ca) and phosphate (P) in children with CKD. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists, who develop clinical practice recommendations (CPRs) for the nutritional management of various aspects of renal disease management in children. We present CPRs for the dietary intake of Ca and P in children with CKD stages 2-5 and on dialysis (CKD2-5D), describing the common Ca-and P-containing foods, the assessment of dietary Ca and P intake, requirements for Ca and P in healthy children and necessary modifications for children with CKD2-5D, and dietary management of hypo-and hypercalcemia and hyperphosphatemia. The statements have been graded, and statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. These CPRs will be regularly audited and updated by the PRNT.

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Phosphate-Containing Prescription Medications Contribute to the Daily Phosphate Intake in a Third of Hemodialysis Patients

Cited by 29 publications

References 18 publications

Overview of the 2017 KDIGO CKD-MBD Update: Practice Implications for Adult Hemodialysis Patients

Overview of the 2017 KDIGO CKD-MBD Update: Practice Implications for Adult Hemodialysis Patients

Effects of Excessive Dietary Phosphorus Intake on Bone Health

The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis—clinical practice recommendation from the Pediatric Renal Nutrition Taskforce

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