Phosphorus binders: The new and the old, and how to choose

Sekar, Arjun; Kaur, Taranpreet; Nally, Joseph V.; Rincon-Choles, Hernan; Jolly, Stacey E.; Nakhoul, Georges

doi:10.3949/ccjm.85a.17054

Cited by 9 publications

(10 citation statements)

References 48 publications

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“…A Western man with a body weight of 70 kg takes in an average of 20 mg Pi/kgBW daily (~400 mg/24 hours), and this man mainly absorbs 13 mg/kgBW (~1000 mg/24 hours) in the ileum, in contrast with haemodialyzed patients who take in 1.1 mg/kgBW daily (800-1000 mg/24 hours). A person on dialysis with end-stage renal disease (ESRD) will lose in a 4-hour dialysis session the 30% of the absorbed Pi (~1000 mg), i.e., 3000 mg/week; whereas the other 30% is eliminated through the intestine using the phosphate binders (10).…”

Section: Discussionmentioning

confidence: 99%

Hyperphosphatemia in Haemodialyzed Patients

Romanidou

Bakaloudis

Georgoulidou

et al. 2022

PIJR

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Dietary regulation of serum phosphate levels is one of the most important therapies for the haemodialyzed patients.This is particularly difficult to apply since these patients must take huge amount of animal proteins that contain a large quantity of phosphate. However, a diet with a small amount of phosphate is required. This guideline is difficult to be implemented because patients get at least 50% of their phosphate from sources that are not obvious and from foods that are easily processed and preserved. In this retrospective study, serum levels of phosphate, calcium and parathyroid hormone were assessed in 123 haemodialyzed patients to determine their levels and differences, depending on age. Patients were grouped into two according to their age. Group A included those who were ≤ 70 years old (n = 55, 29M/26F),and Group B were those > 71 years old (n = 68,39M/29F).Higher phosphate levels were found in Group A with a statistically significant level of p < 0.0001, while overall serum phosphate levels of 47% of patients were below 4.6 mg/dl.Elderly patients with more diabetics (Group B) had lower serum phosphate levels than the younger ones (Group A).Thus, a large percentage of our patients have satisfactory serum phosphate levels, and the younger ones have less satisfactory phosphate levels,compared with the elderly.

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Section: Discussionmentioning

confidence: 99%

Hyperphosphatemia in Haemodialyzed Patients

Romanidou

Bakaloudis

Georgoulidou

et al. 2022

PIJR

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“…In the unlikely event that a phosphorus binder be needed in pregnancy, calcium carbonate is the drug of choice given its safety data as well as a potential supplement of calcium which is necessary for the skeletal development of the fetus. Other phosphorus binders including sevelamer, lanthanum, calcium acetate, ferric citrate, and sucroferric oxyhydroxide are unlikely to be systemically absorbed, but there is a lack of data to recommend or not recommend their use in pregnancy 54 …”

Section: Drug Dosing Considerations In Pregnant Patients On Hemodialysismentioning

confidence: 99%

“…45,48 absorbed, but there is a lack of data to recommend or not recommend their use in pregnancy. 54 Agents used to treat hyperparathyroidism in HD patients such as cinacalcet and etelcalcetide are not recommended for use in pregnancy due to lack of data and risk of hypocalcemia. A few case reports exist of pregnant ESKD patients on calcitriol 0.25 mcg daily for the management of secondary hyperparathyroidism without fetal harm.…”

Section: Phosphorus Managementmentioning

confidence: 99%

Pharmacotherapy considerations in pregnant patients on hemodialysis

Drambarean,

Mastalerz,

Wendt

et al. 2023

Hemodialysis International

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Successful pregnancy rates on dialysis are increasing with the advent of intensive hemodialysis and advances in medical management.Summary: Data support the use of intensive hemodialysis in pregnant women with end-stage kidney disease (ESKD). This paper provides an overview of common pharmacotherapeutic changes in management when caring for a pregnant woman receiving intensive hemodialysis. Pregnant patients on peritoneal dialysis were excluded from this analysis due to insufficient data. Topics covered include those related to anemia (iron and erythropoietin stimulating agents), blood pressure agents, monitoring of phosphorus, as well as nutrition and anticoagulation. Conclusion:When patients on hemodialysis become pregnant, medication adjustments are needed regarding antihypertensives, anemia management, and mineral-bone disease management as many agents require dose adjustment, switching agents due to teratogenicity, or cessation due to fetal complications. There are minimal data in this population; however, successful and healthy infants have been delivered in this patient population with the medication changes discussed.

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“…Sekar et al, 1 in this issue of the Journal, provide an extensive review of the pathophysiology of phosphorus metabolism and strategies to control phosphorus levels in patients with hyperphosphatemia and end-stage kidney disease.…”

Section: See Related Articles Page 584 and Page 629mentioning

confidence: 99%

Phosphorus in kidney disease: Culprit or bystander?

Parmar

2018

CCJM

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Phosphorus binders: The new and the old, and how to choose

Cited by 9 publications

References 48 publications

Hyperphosphatemia in Haemodialyzed Patients

Hyperphosphatemia in Haemodialyzed Patients

Pharmacotherapy considerations in pregnant patients on hemodialysis

Phosphorus in kidney disease: Culprit or bystander?

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