Decrease In Phosphate Levels Research Articles

Effectiveness of tenapanor for treating hyperphosphatemia in patients receiving dialysis: a plain language summary of the OPTIMIZE study

Plain Language Summary What is this summary about? This summary provides a review of the OPTIMIZE study, the results of which were published in Kidney360 in February 2024. The OPTIMIZE study looked at how well tenapanor tablets work to treat patients receiving dialysis who have high levels of phosphate in their blood, a condition called hyperphosphatemia. In the OPTIMIZE study, researchers wanted to understand if tenapanor would decrease phosphate levels in the blood to the target range. They also tested different ways of starting tenapanor treatment in patients. In the human body, kidneys are organs that filter blood and remove waste products. In chronic kidney disease, sometimes referred to as CKD, a patient’s kidneys do not work as well at filtering their blood and removing waste products. This can allow phosphate to build up in the blood. Phosphate levels may remain high despite patients receiving treatment such as dialysis, using pills that keep phosphate in the intestines (called phosphate binders) to prevent phosphate from being absorbed into the blood, and eating a low-phosphate diet. Phosphate levels may remain high despite these treatments because they can be difficult to follow. Most people receiving dialysis take 7–8 phosphate binder pills every day, and over half of those people have reported skipping at least one dose in the past month. Additionally, low-phosphate diets can be difficult to follow and people often struggle to meet their other nutritional needs. What are the key takeaways? Tenapanor used in combination with phosphate binders led to lower phosphate levels in the blood with the use of fewer phosphate-lowering pills. Tenapanor also lowered phosphate levels in patients who were not previously on phosphate binders but needed phosphate-lowering treatment. What were the main conclusions reported by the researchers? Tenapanor can help patients receiving dialysis better control their hyperphosphatemia. This is an abstract of the Plain Language Summary of Publication article. View the full Plain Language Summary PDF of this article to read the full-text Link to original article here

The Effect of HCl Activator on PET Adsorbent to Reduce Phosphate Content in Laundry Waste

<strong>Abstract.</strong> Plastic waste is waste that cannot be decomposed so it will cause serious problems to the environment. The National Waste Management Information System (SIPSN) reported that in 2020 plastic waste was found to be 17.2% of the total waste collected. Several types of plastic can become porous charcoal through the heating process in a furnace so that it can be used as an adsorbent for liquid waste from the laundry industry. Laundry liquid waste containing excess phosphate will disrupt the environment such as eutrophication. This research aims to determine the effect of the HCL activator on carbon from polyethylene terephthalate (PET) plastic bottle waste to reduce phosphate levels in liquid laundry waste. This research uses varying concentrations of HCl as a carbon activator, namely 1M, 5M, and 10M. The activated carbon is added to the liquid laundry waste and stirred at a speed of 100 rpm. Phosphate content analysis was carried out using a spectrophotometer in liquid laundry waste before and after the adsorption process and BET (Brunauer-Emmet-Teller) analysis on activated carbon with activator HCL 10 M. The greatest decrease in phosphate levels was 10 M HCL concentration of 52.87%, with a carbon surface area of 203.1222 m<sup>2</sup>/g and a particle size of 29.53 nm. The adsorption capacity of activated carbon with a 10 M activator is 0.1499 mg/g

Exploring the association between serum phosphate levels and mortality in patients hospitalized with infectious diseases: a nationwide study.

The purpose of this study was to examine associations of serum phosphate levels with mortality, target organ damage and length of hospital stay in adults with infectious diseases hospitalized outside of the intensive care unit. This nationwide retrospective cohort study comprised patients admitted with infections, to medical and surgical departments in eight tertiary hospitals during 2001-2020. The main exposure variable was the first serum phosphate levels at admission (up to 1 week). The analysis included multivariable logistic regression models and quantile regression. Of 126,088 patients (49% males, mean age: 69.3 years), 24,809 (19.7%) had decreased phosphate levels, 92,730 (73.5%) normal phosphate levels, and 8,549 (6.8%) elevated phosphate levels on admission. Overall- and in-hospital mortality rates were highest among those with hyperphosphatemia (74.5 and 16.4%, respectively), followed by those with normophosphatemia (57.0 and 6.6%), and lastly the hypophosphatemia group (48.7 and 5.6%); p < 0.001 for all. After adjusting for confounders, the lowest predicted mortality rate was observed in the normophosphatemia group. In the multivariable model, hyperphosphatemia conferred a higher probability of target organ damage (OR [95% CI]: 2.43 [2.06-2.86]), while moderate hypophosphatemia conferred a lower probability (OR [95% CI]: 0.73 [0.65-0.82]), compared to normal phosphate levels and extreme hypophosphatemia showed a non-significant association (OR [95% CI]: 0.87 [0.57-1.28]). The associations were independent of renal failure. In a multivariable model, hyperphosphatemia was associated with a slight increase of 0.33 days in length of stay compared to normal phosphate levels. A J-shaped relation was found between phosphate levels and prognosis in patients hospitalized with infectious diseases, regardless of their renal function.

Effect of Phytoremediation of Eichornia crassipes (Mart.) Solms and Marsilea crenata C. Persl on Reduction of Phosphate Levels in Laundry Waste

Detergent serves as the most widely used cleaner, one of the ingredients for detergent is phosphate. Excessive phosphate in the waters will cause eutrophication and endanger the aquatic biota in it. Therefore, a solution is needed to reduce phosphate in the waters; one such way is by using Eichornia crassipes (Mart.) Solms and Marsilea crenata C. Presl. The purpose of this study was to determine the effect of plant species and phytoremediation time on phosphate levels in laundry waste. The variables studied were variations in plant species and phytoremediation time. In the plant variety, water hyacinth, water clover, and a combination of the two are used. In the variation of time used 0, 48 and 96 hours. The waste used is waste from a laundry business in Wonokromo, Surabaya. Parameters tested include phosphate, DO, BOD, pH, temperature, and turbidity. The exploration stage is in the form of acclimatisation and range finding tests to determine the concentration of wastewater used in the experimental stage. The results showed that plant species and phytoremediation time affected the decrease in phosphate levels. The correlation between phytoremediation time on parameters of phosphate levels, BOD, and pH will decrease with the duration of phytoremediation, but DO parameters will increase with the duration of phytoremediation.

A Retrospective Single-Center Study of Sevelamer Hydrochloride for the Treatment of Hyperphosphatemia in Children With Tumor Lysis Syndrome.

Introduction Tumor lysis syndrome (TLS) is a life-threatening metabolic abnormality. The incidence of TLS depends on the underlying malignancy. In a recent analysis of hematological malignancy, the incidence of clinical TLS in children was 3.8%, laboratory TLS 46.2%, and hyperphosphatemia 32.7%. Sevelamer is effective for the treatment of hyperphosphatemia associated with renal failure; however,there is no clear data that it has the same effect in treating hyperphosphatemiawith TLS. Methods This was a retrospective study among children aged ≤14 years with hematological malignancy who developed TLS and received sevelamer to treat hyperphosphatemia at Princess Norah Oncology Center, King Abdulaziz Medical City (KAMC) in Jeddah from January 2012 to December 2016. Results A total of 34 patients received sevelamer. The majority was male (64%), with a median age of six years. The median sevelamer dose per day was 1600 mg, while the median duration of use was two days. Phosphate level was significantly decreased at different times(24 hours, 48 hours, and 72 hours) during sevelamer usage, p-value <0.001. Conclusion In our study, the use of sevelamer resulted in a significant decrease in phosphate levels. This finding further consolidates the efficacy of sevelamer in treating hyperphosphatemia with TLS. However, further research into the drug's kinetics is recommended.

Intermittent Bi-Daily Sub-cutaneous Teriparatide Administration in Children With Hypoparathyroidism: A Single-Center Experience.

Introduction: The use of teriparatide has been reported in children with hypoparathyroidism as an investigational physiologic replacement therapy.Methods: We aimed to retrospectively report our pediatric experience of bi-daily sub-cutaneous teriparatide. Results are presented as median (25th−75th quartile). As part of the routine follow-up of these patients with hypoparathyroidism, total calcium at H0 (i.e., just before injection) and H4 (i.e., 4 h after teriparatide injection) and other biomarker parameters were regularly assessed.Results: At a median age of 10.7 (8.1–12.6) years, an estimated glomerular filtration rate (eGFR) of 110 (95–118) mL/min/1.73 m2, calcium levels of 1.87 (1.81–1.96) mmol/L and an age-standardized phosphate of 3.8 (2.5–4.9) SDS, teriparatide therapy was introduced in 10 patients at the dose of 1.1 (0.7–1.5) μg/kg/day (20 μg twice daily), with further adjustment depending on calcium levels. Six patients already displayed nephrocalcinosis. Severe side effects were reported in one child: two episodes of symptomatic hypocalcemia and one of iatrogenic hypercalcemia; one teenager displayed dysgueusia. Calcium levels at H0 did not significantly increase whilst calcium at H4 and phosphate levels significantly increased and decreased, respectively. After 12 months, eGFR, calcium and age-standardized phosphate levels were 108 (90–122) mL/min/1.73 m2, 2.36 (2.23–2.48) mmol/L, 0.5 (−0.1 to 1.5), and 68 (63–74) nmol/L, respectively, with a significant decrease in phosphate levels (p = 0.01). Urinary calcium and calcium/creatinine ratio remained stable; no nephrolithiasis was observed but two moderate nephrocalcinosis appeared.Conclusion: Intermittent teriparatide therapy significantly improves calcium and phosphate control, without increasing calciuria. It appears to be safe and well-tolerated in children.

The Ability of Spirulina sp. Microalgae as A Phytoremediation Agents in Liquid Waste of Handling Fish from Cemara Market, Medan

HighlightMicroalgae Spirullina sp. can remediate BOD levels reach on 75.59% with the experiment was 30% liquid waste and 70% water.Microalgae Spirullina sp. can remediate COD levels reach on 79.19% with the experiment was 30% liquid waste and 70% water.Microalgae Spirullina sp. can remediate TSS levels reach on 83.54% with the experiment was 30% liquid waste and 70% water.Microalgae Spirullina sp. can remediate ammonia levels reach on 89.15% with the experiment was 30% liquid waste and 70% water.AbstractContamination material from fish market activities, namely fish handling liquid waste, is a problem facing the city of Medan today. Reduce the level of liquid waste pollutants can be done biologically by using microalgae organisms. One of them is like microalgae Spirulina sp. This study aims to determine the ability of Spirulina sp. for reducing the levels of pollutants in liquid waste of handling fish.There search method was use a Completely Randomized Design (CRD) with five treatments and three replications. Addition of 100 mL of inoculant Spirulina sp. with a density of 1x105 ind/mL of liquid waste mixed with fresh water with to reach a volume of 1000 mL. Each liquid waste concentration of 30%, 60%, 80%, 100%, and control (0%) added 1 mL Walne fertilizer. The results of initial measurements of liquid waste for parameters BOD, COD, TSS, ammonia, and phosphate, respectively are 26.50mg/L, 4400mg/L, 894mg/L, 1.10mg/L, and 16.7 mg/L. Based on the results, the best reduction in BOD level occured in the treatment of 30% (pA) of liquid waste is 17.64 mg/L with phytoremediation efficiency of 75.59%. The best reduction in COD levels occurred in the treatment of 30% (pA) of liquid waste is 1301.12 mg/L with phytoremediation efficiency of 79.19%. The best reduction in TSS levels occurred in the treatment of 60% (pB) of liquid waste is 411 mg/L with phytoremediation efficiency of 83.54%. The best reduction in ammonia levels was at 30% (pA) treatment, which was 0.38 mg/L with phytoremediation efficiency of 89.15%. While the best decrease in phosphate levels occurred in the control treatment (pK), which was 4.45 mg/L with phytoremediation efficiency of 97.35%.

Computed Tomography-Measured Psoas Muscle Density as a Predictive Factor for Hypophosphatemia Associated With Refeeding.

Initiation of parenteral nutrition (PN) after a period of starvation can be complicated by refeeding syndrome (RFS). RFS is associated with electrolyte abnormalities including hypomagnesemia, hyponatremia, and hypophosphatemia. Risk factors include recent weight loss, low body mass index, and electrolyte deficiencies; however, these associations are not strong. We hypothesized that a validated measure of nutrition risk, computed tomography (CT)-measured psoas muscle density, can be used to predict the development of hypophosphatemia associated with RFS. A retrospective analysis of surgical patients initiated on PN with an abdominal CT scan within the past 3 months was conducted. CT-measured psoas muscle density was assessed as a predictive variable for the development of electrolyte abnormalities. Daily electrolyte and clinical outcome measures were recorded. One hundred nine patients were stratified based on Hounsfield unit average calculation (HUAC). The lowest 25th percentile of patients had HUAC <25. Low HUAC was associated with a significant percent decrease in phosphate levels from baseline to PN day 3 (P < .01) and significant difference in serum phosphate value on PN day 3 (P < .01). The low muscle density quartile also experienced longer days on the mechanical ventilator (P = .01) compared with patients with a higher psoas muscle density. Psoas muscle density predicted the development of hypophosphatemia in patients initiated on PN. This measurement may aid in identifying patients at highest risk of experiencing RFS. Amean psoas HU <25 may prompt additional precautions, including additional phosphate replacement and slower initiation of PN.

Phosphocalcemic responses of vitamin D3 administered intact or hypophysectomized Heteropneustes fossilis maintained either in artificial freshwater or calcium deficient freshwater.

The serum calcium level of vehicle injected fish (group-A) exhibits no alteration throughout the experiment. Vitamin D3 administration to fish Heteropneustes fossilis exhibited hypercalcemia from day 3 to day 7 (group-B). However hypophysectomized and vehicle injected fish showed hypocalcemia from day 3 to day 7 (group-C). While hypophysectomized and vitamin D3 injected fish exhibited hypercalcemia on day 3 till the end of experiment (group -D). The serum phosphate of group A fishes is unaltered throughout experiment. The phosphate level of vitamin D3 treated fish (group-B) exhibits hyperphosphatemia from day 3 to day 7. In group C fishes exhibited a significant decrease in phosphate level throughout the experiment. While the group D fishes showed hyperphosphatemia from day 3 to day 7. In group E fishes the serum calcium level remains unaffected up to day 3 the level decreases on day 5 to day 7. In group F fishes showed hypercalcemia from day 3 to day 7. In group H fishes a progressive decrease in serum calcium level is noticed on day 3 to day 7. The group H fishes shows increase in the serum calcium level from day 3 to day 7. The serum phosphate level of group E fishes showed a decrease from day 3 to day 5. The phosphate level increases from day 3 to day 7 in group F fishes. The phosphate level exhibited a decrease from day 3 to day 7 (group G). The phosphate level increases from day 5 to day 7 of group H fishes.

Assessment of calcium and phosphate levels among Sudanese children with malnutrition: A pilot study in Khartoum state Primary tabs

Malnutrition is a public health problem of significant importance in developing countries, it generally affects everyone in a community, but infants and children are the most vulnerable because of their high nutritional needs for growth and development. This study aimed to assess the levels of calcium and phosphate among Sudanese children with malnutrition. This case control study was conducted in Omdurman hospital in Khartoum, Sudan, during the period from April 2019 to May 2019. Fifty children with malnutrition (case) and 50 healthy children (control) were enrolled in this study; both groups were matched in age and sex. Blood samples were analyzed for calcium and phosphate levels using Mindray BS-200 automated analyzer. There was a significant decrease in phosphate level in malnourished children when compared with healthy children (P-value = 0.00). According to the type of malnutrition, there were significant differences in mean of calcium level; marasmic children had lower mean level (7.1 mg/dL) compared with kwashiorkor and under-nutrition children (9.4 mg/dL). In addition, there was no correlation between serum calcium and phosphate levels with the duration of malnutrition. (r =-0.071. P-value = 0,624) (r = 00.077. P-value = 0.593) respectively. In conclusion: Hypophosphatemia is a common finding among Sudanese malnourished children and marasmic children had decreased level of calcium when compared to other types of malnutrition. Accordingly, it is better to monitor serum phosphate level and other nutritional status within the recovery period.

ANALYSIS OF ORGANIC AND ANORGANIC DEBRIS IN AIR MANIS BEACH, NIRWANA BEACH AND CAROLINA BEACH OF PADANG CITY WEST SUMATERA PROVINCE

This research was conducted in October 2019 to determine the effect of differences in the addition of KH2PO4 concentrations and the concentration of microalgae Scendesmus vacuolatus with experiment method. The results showed significant effect was found on differences in microalgae concentration and KH2PO4 concentration. KH2PO4 with the concentration of 8 ppm is the most influential on decreasing phosphate levels than KH2PO4 with 5 ppm. The highest samples in phosphate reduction were A2, B2 and C2 with different algal formulations and 8 ppm KH2PO4 concentration. Two-way ANOVA test showed sig. 0.000, Which was mean that there were significant effect to decrease levels of phosphate based on concentration. Post hoc DMRT which has a significantly different dominance value of KH2PO4 concentration results that A1, B1, C1 with A2, B2, C2 have significant differences in the decrease in phosphate levels due to differences in KH2PO4 levels.

Post utilization of eceng gondok and ketapang leaf extract to reduce phosphate levels in domestic waste

Utilization of enceng gondok (Eichornia crassipes) and ketapang (Terminalia catappa) was to reduce phosphate levels in domestic waste. This study aims to determine the effectiveness of the combination of E. crassipes and T. cattapa leaf extract in reducing phosphate levels in household wastewater and determine the optimal time that can be generated of the use of a combination of E. crassipes and T. cattapa leaf extract. The approach of this research is an experimental study that aims to treat domestic phosphate-containing wastewater, using small-scale wastewater installations with a simple process for the treatment of waste produced from households. The results of this study showed that the combination of E. crassipes and T. cattapa leaf extract effectively had a significant effect in reducing the value of phosphate content in the wastewater. While the optimal residence time in this study was obtained, a decrease in phosphate levels using a combination of E. crassipes and T. cattapa leaf extract occurred on the 18th day.

Study of microalgae (Scenedesmus Sp.) utilization as phosphate bioremediator (PO4 3−) in domestic wastewater medium

In this research, the use of Scenedesmus sp. as a phosphate bioremediator agent is expected to be applied for lowering the phosphate levels in the water as well as improving the quality of the environment. Scenedesmus sp. used in this research was isolated from Sungai Cideng. Variation of phosphates were tested to see the effect of various types of phosphate found in the waters in the form of a variation of organic phosphates using the Adenosine 5’-monophosphate (AMP), phytic acid and variation of inorganic phosphates using potassium dihydrogen phosphate (KH2PO4) and sodium tripolyphosphate (STPP). It was found that the use of monopotassium phosphate (KH2PO4) was better in decreasing phosphate levels and increasing the number of Scenedesmus sp. cells with a phosphate decrease percentage of 87.5 %. Phosphate test was performed using UV-Vis spectroscopy instrumentation and the abundance of cell count was performed using a microscope and hemocytometer. The environmental quality test parameters are temperature and pH. Direct application in wastewater from Muara Angke was also found the decrease of phosphate levels and increase the number of Scenedesmus sp. cells. Scenedesmus sp. has the ability to reduce nutrients in wastewater to below wastewater quality standard of 86.0 % from the initial phosphate concentration of 0.2255 ppm to 0.0314 ppm.

P658 A pooled analysis of serum phosphate measurements and transient decreased phosphate levels in 45 interventional trials with ferric carboxymaltose

Abstract Background ECCO guidelines acknowledge the limitations of oral iron for iron deficiency anaemia in IBD and recommend first-line IV iron in patients with active disease. Ferric carboxymaltose (FCM) is approved for iron deficiency when oral iron is ineffective/inappropriate. FCM has shown benefit in RCTs, and as with other IV irons, is known to cause a transient decrease in serum phosphate (PO4), which in most cases is asymptomatic. The aim of this pooled analysis was to characterise the frequency, duration, risk factors, and clinical signs of hypophosphataemia (HP) across 45 interventional trials with FCM. Methods 15,080 subjects were included (FCM n = 8,245; controls n = 6,835). 12,683 had post-baseline serum PO4 measurements (FCM n = 6,879), which were pooled by time-point, clinical characteristics, dose, and iron parameters. Serum PO4 thresholds were: 2.5–&amp;lt;4.5 mg/dl (normal), 2.0–&amp;lt;2.5 mg/dl (mild decrease), 1–&amp;lt;2.0 mg/dl (moderate), and &amp;lt;1 mg/dl (severe). Logistic regression analysis was used to identify predictors of HP. MedDRA terms were interrogated for reported and potential clinical signs of HP. Results 2,760 FCM subjects (40.1%) with normal PO4 at baseline developed HP (PO4 &amp;lt;2.5 mg/dl) on study. PO4 levels normalised in 1,705 subjects (61.8%); mean time to normalisation (±SD) was 40.7 days (±35.31). PO4 normalisation during follow-up did not occur in 177 subjects (0.06%). Independent risk factors for moderate/severe HP within 12 weeks of treatment included treatment setting (gastroenterology or neurology vs. women’s health), lower baseline ferritin level, maximum single-dose, advanced age, lower weight at baseline (all p &amp;lt; 0.0001), multiple doses vs. single dose (p = 0.0003), and higher cumulative dose (p = 0.0005). ‘Hypophosphataemia’ as a MedDRA term was approximately 10-fold more frequent with FCM than controls (2.2% vs. 0.2% with other IV irons). Potential clinical signs of HP were not more frequent with FCM vs. controls (Table) and were not associated with nadir levels of serum PO4. 4 of 49 FCM subjects (8.2%) who had nadir PO4 below 1 mg/dl had a potential clinical sign of HP, vs. 126/1,569 (8.0%) with 1–&amp;lt;2.0 mg/dl, 113/1,229 (9.2%) with 2.0–&amp;lt;2.5 mg/dl and 411/4,032 (10.2%) with ≥2.5 mg/dl. Among subjects with PO4 &amp;lt;2.5 mg/dl, serious cardiac disorders classified as potentially related to HP occurred in 14 FCM subjects (0.5%), 1 (0.7%) other IV iron, and 2 (4.4%) oral iron. Conclusion HP is recognised as a common adverse drug reaction with FCM as with several other IV iron preparations. This analysis shows that the transient decreases in PO4 levels were more frequent in patients receiving multiple and/or large doses of FCM but were not associated with an increased rate of potential signs/symptoms of HP.

MON-113 EFFECT OF NUTRITIONAL COUNSELING IN DECREASING PHOSPHATE LEVELS IN HEMODIALYSIS PATIENTS WITH HYPERPHOSPHATEMIA OVER 5 YEARS IN A SINGLE CENTER

Hyperphosphatemia is multifactorial, highly prevalent among hemodialysis (HD) patients and nutritional counseling is an important strategy to decrease phosphate levels. Our objective was to evaluate the potential effect of nutritional counseling in decreasing phosphate levels in HD patients with hyperphosphatemia in the following month as well as possible reasons for lack of success over 5 years. All patients in chronic HD in a single center received nutritional advice during the monthly appointment with the clinic's dietitian based on current results and dietary habits reported by patients. In the occurrence of hyperphosphatemia, a careful evaluation of the consumption of phosphate dietary sources was performed. Nutritional counseling prioritized the achievement or maintenance of adequate protein intake through sources with low phosphorus/protein ratio and the control of inorganic phosphate intake. When indicated, adjustments in the phosphate binder dosage were also suggested. We considered a successful intervention when phosphate levels of hyperphosphatemic patients decreased at any level in the following month. Possible reasons for unsuccessful intervention (when serum phosphate levels were equal or higher in the following month) were registered according to the patient's perception and/or dietitian's evaluation. Over 5 years (2012-2017) there were 6,695 appointments and 3,940 episodes of hyperphosphatemia (59%). There was a decrease in phosphate levels in the following month after nutritional counseling in 60% of the episodes. Possible reasons for lack of success were registered as high phosphate intake plus lack of adherence to phosphate binder prescription in 38%, high phosphate intake in 21%, dialysis inadequacy in 18%, lack of adherence to phosphate binder prescription in 8%, concomitant calcitriol treatment in 6%, unknown and other reason in 9%. Serum phosphate decrease in the following month after nutritional counseling in 60% of hyperphosphatemia episodes during 5 years of observation. The main reason for lack of success was difficulty in adhering to dietary and phosphate binder regimen. Strategies to improve phosphate removal in dialysis procedure and patient's adherence are essential to decrease hyperphosphatemia prevalence in this population.

Analisis Efektivitas Pengikat Fosfat Tablet Kalsium Karbonat yang Dikunyah Dibandingkan yang Ditelan Utuh pada Pasien Penyakit Ginjal Kronis Dengan atau Tanpa Gangguan Saluran Cerna

Chronic Kidney Disease (CKD) patient with Mineral and Bone Disorder complication have to chew calcium carbonate tablet as a phosphate binder, but infact, patient swallow it in a whole. Gastrointestinal (GI) disorders can affect the efficacy of medicine. This study aims to analyze the effectiveness comparation of chewed and whole swallowed calcium carbonate tablet in CKD patients with or without gastrointestinal disorders. This prospective quasi experimental study with non-inferiority design was conducted on May 28th to August 22nd 2012, with 22 sample (stage 3-5 CKD), 14 men, 8 women, divided into 4 groups (1st: patients with GI disorder and whole swallowed calcium carbonate, 2nd: with GI disorders and chewed tablet, 3rd: without GI disorders and whole swallowed tablet, 4th group: without GI disorders and chewed tablet, all tablet are used with meal). Before and after the 6th week research period, calcium and phosphate blood levels measurements had been taken, adherence had been measured every two weeks using the Morisky questionnaire and pill count. The results showed that there was no significant difference in the increased of calcium levels, except for group 1 compared to group 3 (p = 0.027), the decreased phosphate levels (p = 0.724; 0.089; 0.089; 0.414; 0.569; 1.000) and the value of the product calcium-phosphate (p = 1.000; 0.308; 0.186; 0.414; 0.425; 0.728). The conclusion is that the way to use the medicine and the states of gastrointestinal disorders did not significantly influence the effectiveness of calcium carbonate tablet.

Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update.

The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a selective update of the prior CKD-MBD guideline published in 2009. The guideline update and the original publication are intended to assist practitioners caring for adults with CKD and those receiving long-term dialysis. Development of the guideline update followed an explicit process of evidence review and appraisal. The approach adopted by the Work Group and the evidence review team was based on systematic reviews of relevant trials, appraisal of the quality of the evidence, and rating of the strength of recommendations according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Searches of the English-language literature were conducted through September 2015 and were supplemented with targeted searches through February 2017. Final modification of the guidelines was informed by a public review process involving numerous stakeholders, including patients, subject matter experts, and industry and national organizations. The update process resulted in the revision of 15 recommendations. This synopsis focuses primarily on recommendations for diagnosis of and testing for CKD-MBD and treatment of CKD-MBD that emphasizes decreasing phosphate levels, maintaining calcium levels, and addressing elevated parathyroid hormone levels in adults with CKD stage G3a to G5 and those receiving dialysis. Key elements include basing treatment on trends in laboratory values rather than a single abnormal result and being cautious to avoid hypercalcemia when treating secondary hyperparathyroidism.

Phosphate is a potential biomarker of disease severity and predicts adverse outcomes in acute kidney injury patients undergoing continuous renal replacement therapy.

Hyperphosphatemia is associated with mortality in patients with chronic kidney disease, and is common in critically ill patients with acute kidney injury (AKI); however, its clinical implication in these patients is unknown. We conducted an observational study in 1144 patients (mean age, 63.2 years; male, 705 [61.6%]) with AKI who received continuous renal replacement therapy (CRRT) between January 2009 and September 2016. Phosphate levels were measured before (0 h) and 24 h after CRRT initiation. We assessed disease severity using various clinical parameters. Phosphate at 0 h positively correlated with the Acute Physiology and Chronic Health Evaluation II (APACHE II; P < 0.001) and Sequential Organ Failure Assessment (SOFA; P < 0.001) scores, and inversely with mean arterial pressure (MAP; P = 0.02) and urine output (UO; P = 0.01). In a fully adjusted linear regression analysis for age, sex, Charlson comorbidity index (CCI), MAP, and estimated glomerular filtration rate (eGFR), higher 0 h phosphate level was significantly associated with high APACHE II (P < 0.001) and SOFA (P = 0.04) scores, suggesting that phosphate represents disease severity. A multivariable Cox model also showed that hyperphosphatemia was significantly associated with increased 28-day (HR 1.05, 95% CI 1.02–1.08, P = 0.001) and 90-day (HR 1.05, 95% CI 1.02–1.08, P = 0.001) mortality. Furthermore, patients with increased phosphate level during 24 h were at higher risk of death than those with stable or decreased phosphate levels. Finally, c-statistics significantly increased when phosphate was added to a model that included age, sex, CCI, body mass index, eGFR, MAP, hemoglobin, serum albumin, C-reactive protein, and APACHE II score. This study shows that phosphate is a potential biomarker that can reflect disease severity and predict mortality in critically ill patients receiving CRRT.

A Pilot Study of Okkidney, A Phosphate Counting Application in Patients on Peritoneal Dialysis

Hyperphosphatemia is associated with adverse outcomes in patients treated with peritoneal dialysis (PD). We have shown that a fixed meal phosphate binder dosing schedule is not appropriate. The purpose of this study was to evaluate the beta version of OkKidney, a phosphate counting app that matches meal phosphate content with binder dose. A convenience sample of adult patients treated with PD completed a pre-survey that included the technology readiness index (TRI 2.0). After a short information session, patients used OkKidney for 30 days. Pre- and post-intervention serum calcium, serum phosphate, and calcium carbonate binder intake were collected and compared using a paired t-test. A post-intervention survey using a 5-point Likert scale was used to gather patient feedback. Ten patients (5M, 5F) completed the study protocol. Participants were 55 ± 17 years old, predominately Caucasian, retired (60%), and owned a smartphone (70%). The median TRI score was 3.66 (max 5), indicating a moderate level of readiness. The post-survey results indicated a favorable rating for ease of use (μ = 4.4 ± 0.84) and usefulness (μ = 4.3 ± 0.68) of OkKidney. The average serum phosphate (p = 0.99) and calcium (p = 0.68) were not different pre-/post-intervention, but calcium carbonate intake tended to decrease (p = 0.12). Patients reported a positive experience with OkKidney. Further patient-specific adjustments of the binder dose to meal phosphate content may be required to demonstrate a statistically significant decrease in phosphate levels. We believe a larger trial is warranted to investigate the clinical implications of this app.

The galactose-induced decrease in phosphate levels leads to toxicity in yeast models of galactosemia

Classic galactosemia is an inborn error of metabolism caused by deleterious mutations in the GALT gene. A number of evidences indicate that the galactose-1-phosphate accumulation observed in patient cells is a cause of toxicity in this disease. Nevertheless, the consequent molecular events caused by the galactose-1-phosphate accumulation remain elusive. Here we show that intracellular inorganic phosphate levels decreased when yeast models of classic galactosemia were exposed to galactose. The decrease in phosphate levels is probably due to the trapping of phosphate in the accumulated galactose-1-phosphate since the deletion of the galactokinase encoding gene GAL1 suppressed this phenotype. Galactose-induced phosphate depletion caused an increase in glycogen content, an expected result since glycogen breakdown by the enzyme glycogen phosphorylase is dependent on inorganic phosphate. Accordingly, an increase in intracellular phosphate levels suppressed the galactose effect on glycogen content and conferred galactose tolerance to yeast models of galactosemia. These results support the hypothesis that the galactose-induced decrease in phosphate levels leads to toxicity in galactosemia and opens new possibilities for the development of better treatments for this disease.