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Hyperphosphatemia and ESRD

Li Yang, Seng Chuen Tan, Can Chen, Xingzhi Wang, Xinya Li, Xiaoyan Yang
PURPOSE: To conduct a cost-effectiveness analysis study of sevelamer versus calcium-based binders (CBBs) in treating hyperphosphatemia among patients with end-stage renal disease (ESRD) in China. METHODS: A decision-analytic model of a lifetime horizon was used for base case analysis from the payers' perspective. The transition probabilities between different health states were derived from survival analysis. The overall survival of CBBs was derived from the Dialysis Clinical Outcomes Revisited study for up to 44 months and a Weibull regression model was used to extrapolate the overall survival to a lifetime horizon...
October 14, 2016: Clinical Therapeutics
Adamasco Cupisti, Claudia D'Alessandro, Gian Marco Caselli
Nutritional abnormalities and physical inactivity are risk factors of increased morbidity and mortality in patients with ESRD. Identify and define malnutrition, in particular protein-energy depletion (PEW), is an important task in the management of renal patients. The aim of this multicenter observational study was to implement the assessment of nutritional status and functional capacity in patients on peritoneal dialysis, including tests and validated methods which are relatively easy to apply in daily clinical practice...
July 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
N S Zahed, N Zamanifar, H Nikbakht
Hyperphosphatemia is a risk factor for ectopic calcification and coronary artery diseases in end stage renal diseases (ESRD). The aim of this study was to assess the effect of low-dose nicotinic acid on hyperphosphatemia in patients with ESRD. This randomized, double-blind clinical trial was done on 70 ESRD patients with serum phosphoure ≥5.5 mg/dl. Patients were randomly divided into two equal groups (n = 35) and the intervention group received niacin 25 mg/day as the initial dose. After 4 weeks, in patients who did not respond to treatment, niacin dose was increased up to 50 mg/dl...
July 2016: Indian Journal of Nephrology
Ross Robison, Danielle Cooney, Mary Beth Low, Niraj Desai
BACKGROUND: Hyperphosphatemia is a common problem in patients with chronic kidney disease (CKD). Calcium-containing phosphate binders are typically used as first-line therapy, primarily due to cost considerations. Non-calcium phosphate binders such as sevelamer and lanthanum may be considered in the appropriate setting. It is hypothesized that lanthanum is less costly and has a lower pill burden compared to sevelamer carbonate. OBJECTIVE: Determine the difference in cost (outcome 1) and tablet burden (outcome 2) between sevelamer carbonate and lanthanum within the Veteran population...
April 2016: Hospital Pharmacy
Wen Xiu Chang, Ning Xu, Takanori Kumagai, Takeshi Shiraishi, Takahiro Kikuyama, Hiroki Omizo, Kazuhiro Sakai, Shigeyuki Arai, Yoshifuru Tamura, Tatsuru Ota, Shigeru Shibata, Yoshihide Fujigaki, Zhong Yang Shen, Shunya Uchida
BACKGROUND: Although hyperphosphatemia is deemed a risk factor of the progression of chronic kidney disease (CKD), it remains unclear whether the normal range of serum phosphorus likewise deteriorates CKD. A propensity score analysis was applied to examine the causal effect of the normal range of serum phosphorus on the incidence of end-stage renal disease (ESRD). METHODS: A retrospective CKD cohort of 803 participants in a single institution was analyzed. Propensity score was estimated using 22 baseline covariates by multivariate binary logistic regression for the different thresholds of time-averaged phosphorus (TA-P) in the normal range of serum phosphorus incremented by 0...
2016: PloS One
Yoram Yagil, Stephen Z Fadem, Kotagal S Kant, Udayan Bhatt, Mohammed Sika, Julia B Lewis, Dana Negoi
Ferric citrate is a novel phosphate binder that allows the simultaneous treatment of hyperphosphatemia and iron deficiency in patients being treated for end-stage renal disease with hemodialysis (HD). Multiple clinical trials in HD patients have uniformly and consistently demonstrated the efficacy of the drug in controlling hyperphosphatemia with a good safety profile, leading the US Food and Drug Administration in 2014 to approve its use for that indication. A concurrent beneficial effect, while using ferric citrate as a phosphate binder, is its salutary effect in HD patients with iron deficiency being treated with an erythropoietin-stimulating agent (ESA) in restoring iron that becomes available for reversing chronic kidney disease (CKD)-related anemia...
September 2015: Therapeutic Advances in Chronic Disease
Jessica Kendrick, Michel Chonchol
Abnormalities in mineral metabolism are a universal complication in dialysis patients and are associated with an increased risk of cardiovascular disease and mortality. Hyperphosphatemia, increased fibroblast growth factor 23 levels and secondary hyperparathyroidism are all strongly associated with adverse outcomes in end stage renal disease (ESRD) and most treatment strategies target these parameters. Over the past few years, new therapies have emerged for the treatment of abnormalities of mineral metabolism in ESRD and many are promising...
November 2015: Seminars in Dialysis
Roger A Rodby, Kausik Umanath, Robert Niecestro, T Christopher Bond, Mohammed Sika, Julia Lewis, Jamie P Dwyer
BACKGROUND: Patients with end-stage renal disease (ESRD) require phosphate binders for hyperphosphatemia and erythropoiesis-stimulating agents (ESAs) and intravenous (i.v.) iron for anemia. Ferric citrate (FC) is a novel, iron-based phosphate binder that increases iron stores and decreases i.v. iron and ESA usage while maintaining hemoglobin levels, and may decrease the cost of ESRD care. The study objectives were to (1) quantify differences in ESA and i.v. iron usage among ESRD patients receiving FC compared with active control (AC) (sevelamer carbonate and/or calcium acetate) on the basis of data from a 52-week phase III clinical trial and (2) standardize trial data to the general United States (US) ESRD population and calculate the potential impact of FC on ESRD cost/patient/year in the USA...
September 2015: Drugs in R&D
Da Shang, Qionghong Xie, Xiaolin Ge, Huanqing Yan, Jing Tian, Dingwei Kuang, Chuan-Ming Hao, Tongying Zhu
BACKGROUND: Coronary artery calcification (CAC) is associated with cardiovascular mortality in end-stage renal disease (ESRD) patients. The present study aimed to identify modifiable risk factors for CAC progression in peritoneal dialysis (PD) patients. METHODS: Adult patients who received regular PD for more than 6 months and underwent a series of coronary artery calcification score (CaCS) measurements by multislice spiral computed tomography (MSCT) with an interval of ≥ 6 months were included in this observational cohort study...
2015: BMC Nephrology
Mayuree Tangkiatkumjai, Helen Boardman, Kearkiat Praditpornsilpa, Dawn-Marie Walker
AIMS: To determine associations between herbal and dietary supplement (HDS) use and the progression of chronic kidney disease (CKD), and associations of HDS with uncontrolled hyperphosphatemia in patients with CKD. METHOD: The cohort study recruited 406 Thai outpatients with stage 3-5 CKD from two kidney clinics of which 357 were followed up over 12 months. Patients receiving renal replacement therapy prior to recruitment were excluded. Participants were interviewed regarding their HDS use, dietary intake and conventional medication adherence using a questionnaire...
June 4, 2015: Nephrology
Takashi Shigematsu, Masaki Ohya, Shigeo Negi, Asuka R Masumoto, Yuri M Nakashima, Yuka Iwatani, Mari K Moribata, Shintaro Yamanaka, Kouichi Tatsuta, Toru Mima
In end-stage renal disease patients, various abnormalities of bone mineral metabolism adversely affect mortality. Hyperphosphatemia is known to adversely affect mortality and quality of life in chronic kidney disease patients and has been shown to be involved not only in the onset and progression of secondary hyperparathyroidism but also in vascular calcification. Thus, hyperphosphatemia is the main treatment target indicated in several guidelines for chronic kidney disease-mineral and bone disorder treatment...
2015: Contributions to Nephrology
Haitham Ezzat, Amr Mohab
Sleep disorders are common among the patients undergoing dialysis in end stage renal disease (ESRD). Although variable, their prevalence has been reported to be higher when compared to the general population. The most frequently reported complaints are insomnia, restless leg syndrome (RLS), sleep-disordered breathing and excessive daytime sleepiness (EDS). The aim of this study was to assess the prevalence of sleep disorders in end stage renal disease patients on regular hemodialysis (group I with 30 patients) and CKD patients (group II with 30 patients) in comparison to 30 normal population (control group)...
July 2015: Renal Failure
Ebele M Umeukeje, Joseph R Merighi, Teri Browne, Jacquelyn N Victoroff, Kausik Umanath, Julia B Lewis, T Alp Ikizler, Kenneth A Wallston, Kerri Cavanaugh
OBJECTIVE: Hyperphosphatemia is common in end-stage renal disease and associates with mortality. Phosphate binders reduce serum phosphorus levels; however, adherence is often poor. This pilot study aims to assess patients' self-motivation to adhere to phosphate binders, its association with phosphorus control, and potential differences by race. DESIGN AND METHODS: Cross sectional design. Subjects were enrolled from one academic medical center dialysis practice from July to November 2012...
September 2015: Journal of Renal Nutrition
Kanako Katai, Aya Iwamoto, Yuka Kimura, Yuki Oshima, Saori Arioka, Yuki Morimi, Ayaka Omuro, Teruko Nakasa
In chronic renal failure, inorganic phosphate (Pi) retention speeds up the progression to end-stage renal disease. The current therapy for hyperphosphatemia in patients with chronic renal failure consists of dietary Pi restriction combined with administration of Pi binders, but each therapy has practical problems. Thus, the discovery of foods or nutrients that inhibit Pi absorption may be useful for the treatment of hyperphosphatemia. In the present study, we investigated whether wakame (Undaria pinnatifida) is a useful food for the prevention of hyperphosphatemia in a rat model of renal failure...
2015: Journal of Medical Investigation: JMI
Ramón Alberto Tamayo-Isla, Mauro Cuba de la Cruz
INTRODUCTION: Calciphylaxis is a rare medical condition that is usually diagnosed in patients suffering from end-stage renal disease who are already receiving renal replacement therapy and in those post-transplantation. The pathogenesis still remains to be fully elucidated; hence, the treatment is not uniform. The prognosis is generally poor. The ulcerative stage exhibits a worse prognosis than the nonulcerative one. Calciphylaxis presenting in terminal kidney disease prior to dialytic treatment has only rarely been reported...
2015: International Journal of Nephrology and Renovascular Disease
Matthew B Rivara, Vanessa Ravel, Kamyar Kalantar-Zadeh, Elani Streja, Wei Ling Lau, Allen R Nissenson, Bryan Kestenbaum, Ian H de Boer, Jonathan Himmelfarb, Rajnish Mehrotra
Uncorrected serum calcium concentration is the first mineral metabolism metric planned for use as a quality measure in the United States ESRD population. Few studies in patients undergoing either peritoneal dialysis (PD) or hemodialysis (HD) have assessed the association of uncorrected serum calcium concentration with clinical outcomes. We obtained data from 129,076 patients on dialysis (PD, 10,066; HD, 119,010) treated in DaVita, Inc. facilities between July 1, 2001, and June 30, 2006. After adjustment for potential confounders, uncorrected serum calcium <8...
July 2015: Journal of the American Society of Nephrology: JASN
Karthik Ramakrishnan, Peter Braunhofer, Britt Newsome, Deborah Lubeck, Steven Wang, Jennifer Deuson, Ami J Claxton
INTRODUCTION: Hyperphosphatemia (serum phosphorus >5.5 mg/dL) in hemodialysis patients is a key factor in mineral and bone disorders and is associated with increased hospitalization and mortality risks. Treatment with oral phosphate binders offers limited benefit in achieving target serum phosphorus concentrations due to high daily pill burden (7-10 pills/day) and associated poor medication adherence. The economic value of improving phosphate binder adherence and increasing percent time in range (PTR) for target phosphorus concentrations has not been previously assessed in dialysis patients...
December 2014: Advances in Therapy
T M-H Nguyen, R H Müller, M Taupitz, J Schnorr, B Hamm, S Wagner
Hyperphosphatemia is one of the main risk factors contributing to morbidity and mortality in patients with end stage renal disease. The demand for a new phosphate binder is continuously increasing since the number of patients suffering under hyperphosphatemia is growing. However, side effects and high pill burden of currently available phosphate binders are the main reasons for low compliance and uncontrolled serum phosphate levels. Therefore, the aim of this study was to develop a novel phosphate binder with a high phosphate binding capacity over the entire gastrointestinal (GI) pH range...
March 30, 2015: International Journal of Pharmaceutics
Keitaro Yokoyama
In patients with end-stage renal disease (ESRD) , hyperphosphatemia contributes to secondary hyperparathyroidism and can lead to skeletal complications including fracture, and vascular calcification. Currently employed phosphate binders include calcium carbonate, sevelamer hydrochloride, and lanthanum carbonate. While these agents are effective at binding orally ingested phosphates, they vary in safety, potency, and off-target effects, some of which may be salutary (e.g., low-density lipoprotein and uric acid lowering with sevelamer) and others adverse (low turnover bone disease and progressive vascular calcification with calcium) ...
December 2014: Clinical Calcium
Yogesh Nv Reddy, Varun Sundaram, Georgi Abraham, Prethivee Nagarajan, Yuvaram Nv Reddy
There has been an exponential increase in the incidence of diabetes and hypertension in India in the last few decades, with a proportional increase in chronic kidney disease (CKD). Preventive health care and maintenance of asymptomatic chronic disease such as CKD are often neglected by patients until they become symptomatic with fluid retention and uremia. Management of hyperphosphatemia in CKD remains one of the challenges of nephrology in India for this reason, as it is almost completely asymptomatic but contributes to renal osteodystrophy, metastatic vascular calcification, and acceleration of cardiovascular disease...
2014: International Journal of Nephrology and Renovascular Disease
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