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nutrition hyperphosphatemia

Giorgina Barbara Piccoli, Maria Rita Moio, Antioco Fois, Andreea Sofronie, Lurlinys Gendrot, Gianfranca Cabiddu, Claudia D'Alessandro, Adamasco Cupisti
The history of dialysis and diet can be viewed as a series of battles waged against potential threats to patients' lives. In the early years of dialysis, potassium was identified as "the killer", and the lists patients were given of forbidden foods included most plant-derived nourishment. As soon as dialysis became more efficient and survival increased, hyperphosphatemia, was identified as the enemy, generating an even longer list of banned aliments. Conversely, the "third era" finds us combating protein-energy wasting...
April 10, 2017: Nutrients
Cristina Garagarza, Ana Valente, Cristina Caetano, Telma Oliveira, Pedro Ponce, Ana Paula Silva
PURPOSE: The aim of the present study was to investigate the relationship between serum phosphate levels, clinical parameters, body composition, and mortality. METHODS: Multicenter longitudinal observational study of a cohort of 3552 patients in hemodialysis (HD) from 34 Nephrocare dialysis units in Portugal with 24 months of follow-up. Patients were divided into three groups depending on their serum phosphorus (<3.5; 3.5-5.5; >5.5 mg/dL). Statistical tests were performed with SPSS, version 20...
March 6, 2017: International Urology and Nephrology
Khawla Kammoun, Hanen Chaker, Hichem Mahfoudh, Nouha Makhlouf, Faical Jarraya, Jamil Hachicha
BACKGROUND: Mediterranean diet is characterized by low to moderate consumption of animal protein and high consumption of fruits, vegetables, bread, beans, nuts, seeds and other cereals. It has been associated with reduced risk of cardiovascular disease. However, it is not suitable for chronic kidney disease because of high potassium intake. DISCUSSION: Tunisia is an emerging Mediterranean country with limited resources, a high prevalence of chronic hemodialysis treatment and high dialysis expenditures...
January 23, 2017: BMC Nephrology
Morgan Marcuccilli, Michel Chonchol, Anna Jovanovich
In advanced renal disease, the kidney is unable to maintain phosphate balance due to decreased urinary excretion as well as the imbalance of the bone metabolic axis. It is well established that hyperphosphatemia is associated with increased cardiovascular events and mortality in patients with chronic kidney disease (CKD). However, there are no randomized controlled trials that demonstrate a clear benefit on hard outcomes in lowering serum phosphate levels to recommended targets in the CKD or dialysis population...
January 8, 2017: Seminars in Dialysis
L Salomo, A-L Kamper, G M Poulsen, S K Poulsen, A Astrup, M Rix
Hyperphosphatemia in chronic kidney disease (CKD) is associated with vascular calcification, cardiovascular morbidity and mortality. The aim of this study was to estimate the daily dietary phosphorus intake compared with recommendations in CKD patients and to evaluate the reproducibility of the 24-h urinary phosphorus excretion. Twenty CKD patients stage 3-4 from the outpatient clinic, collected 24-h urine and kept dietary records for 3 consecutive days. The mean daily phosphorus intake was 1367±499, 1642±815 and 1426±706 mg/day, respectively (P=0...
December 14, 2016: European Journal of Clinical Nutrition
Shahrzad Ossareh, Farhat Farrokhi, Marjan Zebarjadi
INTRODUCTION: This study aimed to evaluate the outcome and predictors of survival in hemodialysis patients of Hasheminejad Kidney Center where a comprehensive dialysis care program has been placed since 2004. MATERIALS AND METHODS: Data of 560 hemodialysis patients were used to evaluate 9-year survival rates and predictors of mortality. Cox regression models included comorbidities as well as averaged and 6-month-averaged time-dependent values of laboratory findings as independent factors...
November 2016: Iranian Journal of Kidney Diseases
Jing-Quan Zheng, Yi-Chou Hou, Cai-Mei Zheng, Chien-Lin Lu, Wen-Chih Liu, Chia-Chao Wu, Ming-Te Huang, Yuh-Feng Lin, Kuo-Cheng Lu
BACKGROUND: Active Vitamin D analogues are used clinically for prevention and treatment of secondary hyperparathyroidism (SHPT) in hemodialysis (HD) patients. Nutritional vitamin D supplementation is used for additional local parathyroid (PTH) suppression, with lower incidence of hypercalcemia and hyperphosphatemia. This study evaluates the possible beneficial effects of combined vitamin D treatment (paricalcitol and cholecalciferol). METHODS: Sixty HD patients with serum parathyroid hormone (iPTH) >300 pg/mL were enrolled...
November 5, 2016: Nutrients
Adamasco Cupisti, Claudia D'Alessandro, Biagio Di Iorio, Anna Bottai, Claudia Zullo, Domenico Giannese, Massimiliano Barsotti, Maria Francesca Egidi
BACKGROUND: Dietary treatment is helpful in CKD patients, but nutritional interventions are scarcely implemented. The main concern of the renal diets is its feasibility with regards to daily clinical practice especially in the elderly and co-morbid patients. This study aimed to evaluate the effects of a pragmatic, step-wise, personalized nutritional support in the management of CKD patients on tertiary care. METHODS: This is a case-control study. It included 823 prevalent out-patients affected by CKD stage 3b to 5 not-in-dialysis, followed by tertiary care in nephrology clinics; 305 patients (190 males, aged 70 ± 12 years) received nutritional support (nutritional treatment Group, NTG); 518 patients (281 males, aged 73 ± 13 years) who did not receive any dietary therapy, formed the control group (CG)...
September 6, 2016: BMC Nephrology
Adamasco Cupisti, Claudia D'Alessandro, Gian Marco Caselli, M F Egidi, A Bottai, F E Onnis, A Mecacci, M Bernardi, A Mencherini, G Bruzzichelli, A Marzocchi, S Michelassi, I Benedetti, S Bonini, M Belluardo, A Tozzi, A Papi, A Cioni, C Sordini, D Rolle, A Carlini, I Lucarotti, R Lucarini, M Barattini, S Sposini, M Briglia, F Ceccarelli, C Del Corso, W Lunardi, G Betti, B Catania, E Carlotti, S Buglioni, S Aterini, F Errichiello, C Colzi, V Finato, S Bianchi, R Fogli, F Cappelletti, C Mechini, A Redi, F Santori, F Cassioli, E Giovannetti, G Simona, N Malacarne
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
Ivica Vrdoljak, Ines Panjkota Krbavčić, Martina Bituh, Ninoslav Leko, Draško Pavlović, Tea Vrdoljak Margeta
INTRODUCTION: Control of serum phosphate is important for patients on hemodialysis. The aim of the study was to determine if education based on phosphorus-reducing techniques in food preparation and thermal processing, and accordingly prepared and applied diets, will lead to better outcomes than a standard education program to improve phosphate control in patients on hemodialysis. METHODS: Forty-seven patients on hemodialysis were divided between an intervention and a control group...
April 2017: Hemodialysis International
John P Bilezikian, Maria Luisa Brandi, Natalie E Cusano, Michael Mannstadt, Lars Rejnmark, René Rizzoli, Mishaela R Rubin, Karen K Winer, Uri A Liberman, John T Potts
CONTEXT: Conventional management of hypoparathyroidism has focused upon maintaining the serum calcium with oral calcium and active vitamin D, often requiring high doses and giving rise to concerns about long-term consequences including renal and brain calcifications. Replacement therapy with PTH has recently become available. This paper summarizes the results of the findings and recommendations of the Working Group on Management of Hypoparathyroidism. EVIDENCE ACQUISITION: Contributing authors reviewed the literature regarding physiology, pathophysiology, and nutritional aspects of hypoparathyroidism, management of acute hypocalcemia, clinical aspects of chronic management, and replacement therapy of hypoparathyroidism with PTH peptides...
June 2016: Journal of Clinical Endocrinology and Metabolism
Lisa Gutekunst
Control of serum phosphorus (PO4) has been long recognized as a goal in the nutritional and medical management of the patients with chronic kidney disease. Phosphate-binding compounds were introduced in the 1970s for the treatment of hyperphosphatemia in patients on dialysis after it was observed that oral administration of aluminum hydroxide as an antacid also reduced serum PO4 levels. Forty years later, aluminum is very seldom used as a phosphate binder as many other safer compounds are now available. This article is a comprehensive review, geared to the renal dietitian, of the most common binder categories...
July 2016: Journal of Renal Nutrition
Csaba P Kovesdy, Kamyar Kalantar-Zadeh
Lowering dietary protein intake (DPI) to approximately 0.6-0.8 g/kgBW/day may be renoprotective through various mechanisms, and it has been recommended in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) as a means to also control various metabolic consequences of advanced CKD, such as uremic symptoms, hyperparathyroidism, hypertension, hyperkalemia, and hyperphosphatemia. A meta-analysis in this issue of the Journal suggests that low-protein diet is effective and safe when used to retard progression of CKD and alleviate uremic complications...
May 2016: International Urology and Nephrology
David E St-Jules, Kathleen Woolf, Mary Lou Pompeii, Kamyar Kalantar-Zadeh, Mary Ann Sevick
Dietary phosphorus restriction is recommended to help control hyperphosphatemia in hemodialysis patients, but many high-phosphorus foods are important sources of protein. In this review, we examine whether restricting dietary phosphorus compromises protein status in hemodialysis patients. Although dietary phosphorus and protein are highly correlated, phosphorus intakes can range up to 600 mg/day for a given energy and protein intake level. Furthermore, the collinearity of phosphorus and protein may be biased because the phosphorus burden of food depends on: (1) the presence of phosphate additives, (2) food preparation method, and (3) bioavailability of phosphorus, which are often unaccounted for in nutrition assessments...
May 2016: Journal of Renal Nutrition
Mark R Haussler, G Kerr Whitfield, Carol A Haussler, Marya S Sabir, Zainab Khan, Ruby Sandoval, Peter W Jurutka
1,25-Dihydroxyvitamin D3 (1,25D) is the renal metabolite of vitamin D that signals through binding to the nuclear vitamin D receptor (VDR). The ligand-receptor complex transcriptionally regulates genes encoding factors stimulating calcium and phosphate absorption plus bone remodeling, maintaining a skeleton with reduced risk of age-related osteoporotic fractures. 1,25D/VDR signaling exerts feedback control of Ca/PO4 via regulation of FGF23, klotho, and CYP24A1 to prevent age-related, ectopic calcification, fibrosis, and associated pathologies...
2016: Vitamins and Hormones
Zheng Jiang, Xiaoyan Zhang, Lichuan Yang, Zi Li, Wei Qin
BACKGROUND: To evaluate the efficacy and safety of the restricted protein diet (low or very low protein diet) supplemented with keto analogues in the treatment of chronic kidney disease (CKD). METHODS: The Cochrane library, PubMed, Embase, CBM and CENTRAL databases were searched and reviewed up to April 2015. Clinical trials were analyzed using RevMan 5.3 software. RESULTS: Seven random control trials, one cross-over trial and one non-randomized concurrent control trial were selected and included in this study according to our inclusion and exclusion criteria...
March 2016: International Urology and Nephrology
Coral Parikh, Victoria Gutgarts, Elliot Eisenberg, Michal L Melamed
Most dialysis patients are vitamin D deficient, including deficiencies in both activated vitamin D (1, 25-dihydroxyvitamin D) and the less active 25-hydroxyvitamin D. These and other abnormalities associated with chronic kidney disease (CKD), if they remain untreated, lead to secondary hyperparathyroidism and bone changes, such as osteitis fibrosa cystica. Activated vitamin D has been proven to decrease parathyroid hormone (PTH) levels in dialysis patients and is currently used for this indication. There are multiple other potential "pleotrophic" effects associated with vitamin D therapy...
November 2015: Seminars in Dialysis
Jemma McCutcheon, Katrina Campbell, Maree Ferguson, Sarah Day, Megan Rossi
OBJECTIVE: Phosphorus-based food additives may pose a significant risk in chronic kidney disease given the link between hyperphosphatemia and cardiovascular disease. The objective of the study was to determine the prevalence of phosphorus-based food additives in best-selling processed grocery products and to establish how they were reported on food labels. DESIGN: A data set of 3000 best-selling grocery items in Australia across 15 food and beverage categories was obtained for the 12 months ending December 2013 produced by the Nielsen Company's Homescan database...
September 2015: Journal of Renal Nutrition
William Beaubien-Souligny, Sarah Bezzaoucha, Vincent Pichette, Jean-Philippe Lafrance, Robert Bell, Caroline Lamarche, Denis Ouimet, Michel Vallee
PURPOSE: Hyperphosphatemia and metabolic acidosis are frequently encountered in advanced chronic kidney disease (CKD) patients. Correction of metabolic acidosis in patients with advanced CKD leads to a decrease in the progression of renal impairment and improves nutritional outcomes. Lanthanum carbonate is used for control of hyperphosphatemia. This study evaluated the effect of lanthanum carbonate on metabolic acidosis in CKD IV-V patients and in patients on dialysis. METHODS: Retrospective data of patients in whom lanthanum carbonate therapy was initiated were collected from 2009 to 2013 in a single dialysis center...
July 2015: International Urology and Nephrology
Ivica Vrdoljak, Ines Panjkota Krbavčić, Martina Bituh, Tea Vrdoljak, Zoran Dujmić
OBJECTIVE: To analyze how different thermal processing methods affect the protein, calcium, and phosphorus content of hospital food served to dialysis patients and to generate recommendations for preparing menus that optimize nutritional content while minimizing the risk of hyperphosphatemia. DESIGN AND METHODS: Standard Official Methods of Analysis (AOAC) methods were used to determine dry matter, protein, calcium, and phosphorus content in potatoes, fresh and frozen carrots, frozen green beans, chicken, beef and pork, frozen hake, pasta, and rice...
May 2015: Journal of Renal Nutrition
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