Hyperphosphatemia In End-stage Renal Disease Patients Research Articles

The efficacy and safety of niacin on hyperphosphatemia in ESRD patients undergoing hemodialysis: randomized controlled trial

BackgroundHyperphosphatemia is a common complication of end-stage renal disease (ESRD) and particularly affects hemodialysis (HD) patients. Elevated serum phosphorus contributes to the development of secondary hyperparathyroidism, chronic kidney disease–mineral bone disorder (CKD-MBD), metastatic calcifications and calcific uremic arteriolopathy. There is a significant association between hyperphosphatemia and increased morbidity and mortality in ESRD patients including cardiovascular morbidity and mortality, and it is also associated with prolonged hospitalization of HD patients. This study aim to evaluate the serum phosphorus lowering effect of niacin in HD patients.ResultsThere was a decrease in phosphate values during the first 3 months of the study in the niacin group, with a significant change in phosphate level at the third month (5.90 ± 0.52 vs. 6.42 ± 0.65 (mEq/l); P < 0.001) and at the sixth month (5.12 ± 0.41 vs. 5.76 ± 0.47 (mEq/l); P < 0.001) compared to the control group. It was noted that both groups had an insignificant difference regarding baseline parathormone (PTH), though the PTH showed a significantly lower level at the third month (192.39 ± 78.85 vs. 388.27 ± 263.10 pg/ml; P < 0.001) and at the sixth month (127.56 ± 90.87 vs. 249.85 ± 97.69 pg/ml; P < 0.001) in the niacin group.ConclusionNiacin caused a statistically significant decrease in levels of phosphate and PTH in dialysis patients.Trial registrationRegistered at ClinicalTrials.gov NCT03163576. Trial registration date: 22 May 2017. Date of first patient’s enrolment: 1 October 2018. Date of the ethical committee approval: 29 March 2017. Number of the ethical committee approval: 17100040.

PUK11 COST EFFECTIVENESS OF PHARMACEUTICAL TREATMENT OF HYPERPHOSPHATEMIA WITH PHOSPHATE BINDERS: A SYSTEMATIC REVIEW

Hyperphosphatemia is associated with morbidity and mortality in end-stage renal disease (ESRD) patients. Phosphate binders (PBs) are the primary therapeutic treatment for hyperphosphatemia in ESRD patients receiving dialysis. Calcium-based binders are associated with an increased morbidity and mortality risk. Medicare spending on PBs has been estimated to be over $1.5 billion. The purpose of this study was to review economic evaluations of PBs to better understand their value. We conducted a systematic literature review of the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar using the search terms “phosphate binder”, “hyperphosphatemia”, “ESRD”, “cost”, and “economic”. Results: were limited to recent economic evaluations published in English in peer reviewed journals between January 2015 and December 2019. Studies included in the review reported cost-effectiveness outcomes. Our search initially identified 84 publications. After removing irrelevant articles and duplicates, 5 publications met our inclusion criteria and were included in our review. Four of the five studies compared either sevelamer carbonate (SEV) or lanthanum carbonate (LC) to calcium-based binders. These analyses found SEV or LC to be cost-effective compared to calcium-based binders. A fifth study evaluated the cost effectiveness of two non-calcium-based phosphate binders, sucroferric oxyhydroxide (SO) and SEV, and found SO to be cost effective relative to SEV. This review demonstrates the need for more high-quality economic evaluations of phosphate binders. The use of calcium-based binders as a comparator group is sub-optimal given the risk they may pose to patients. Only one study, which found sucroferric oxyhydroxide to be cost-effective, was found that compared non-calcium-based binders.

HYPERPHOSPHATEMIA IN END STAGE RENAL DISEASE: PREVALENCE AND PATIENTS CHARACTERISTICS OF MULTIETHNIC POPULATION OF UNITED ARAB EMIRATES

Objective: Hyperphosphatemia is significantly associated with increased mortality among end stage renal disease (ESRD) patients on hemodialysis. There is paucity of data on hyperphosphatemia in ESRD patients of the multiethnic population of United Arab Emirates (UAE). The study aimed to investigate the prevalence and characteristics of hyperphosphatemia in ESRD patients of the multiethnic population of UAE undergoing maintenance hemodialysis.Methods: Adults ESRD patients undergoing maintenance hemodialysis for more than six months at the study site were included. Demographic, clinical and biological data of the patients were collected. Patient characteristics were compared as per the serum phosphate level, between patients with or without hyperphosphatemia. Univariate and multivariate logistic regression analyses were carried out to identify the predictors of hyperphosphatemia.Results: Hyperphosphatemia was present in 73.8% of the study population, while 31.3% presented with high calcium-phosphate product. Univariate logistic analysis revealed that hyperphosphatemia was inversely correlated with age, hemoglobin, serum calcium, and hypertensive nephropathy as cause of renal disease, and positively correlated with female gender, expatriate status, body mass index (BMI), higher number of comorbidities, calcium-phosphate product and parathyroid hormone (PTH). Multivariate logistic regression model revealed that only age, BMI, hemoglobin and PTH independently correlated with hyperphosphatemia.Conclusion: We report a high prevalence of hyperphosphatemia in multiethnic study population undergoing maintenance hemodialysis at a secondary care hospital in UAE. In this study population, only age, BMI, hemoglobin and PTH were identified as independent predictors of hyperphosphatemia.

Use of Nicotinamide to Treat Hyperphosphatemia in Dialysis Patients

Hyperphosphatemia in chronic kidney disease (CKD) has been associated with elevated cardiovascular morbidity and mortality. Serum phosphate control remains a cornerstone of the clinical management of patients with CKD, in order to both attenuate the progression of secondary hyperparathyroidism or bone disease and (possibly) reduce the risk of vascular calcification. Despite technical improvements in dialysis and the use of dietary restrictions, drug therapy is often required to control phosphate levels in patients with end-stage renal disease (ESRD). Currently available medications for hyperphosphatemia in ESRD are very expensive and not always well tolerated. The discovery and development of new drugs in this indication is therefore a priority for both medical and health-economic reasons. Nicotinamide (an amide derivative of the water-soluble vitamin B3) is a potentially interesting alternative to phosphate binders. In vitro and in vivo data show that nicotinamide reduces hyperphosphatemia by inhibiting sodium-dependent phosphate co-transport in the renal proximal tubule and in the intestine. Accordingly, targeting the sodium-dependent phosphate co-transporter 2b by using nicotinamide as an alternative or adjunct to classical phosphate binders may be a therapeutic option for modulating serum phosphate in CKD. Several recent clinical studies have explored the potential value of nicotinamide in phosphate control (as well as its effects on lipid levels) in dialysis patients. However, we consider that more data on pharmacodynamics, pharmacokinetics and safety are needed before this compound can be recommended as a treatment for hyperphosphatemia in ESRD patients.

Hyperphosphatemia in Dialysis Patients: The Therapeutic Role of Lanthanum Carbonate

Phosphate overload is a dramatic consequence in end-stage renal disease (ESRD) patients. Recent studies have well documented that abnormalities in mineral and bone metabolism in these patients are associated with increased cardiovascular morbidity and mortality. Elevated serum phosphate and calcium-phosphate product levels play an important role in the pathogenesis of secondary hyperparathyroidism and extra-skeletal calcification in dialysis patients. Furthermore, inorganic phosphate may cause vascular calcification directly through a real ""ossification"" of the tunica media in the vasculature of ESRD patients. The ""classical"" treatment of secondary hyperparathyroidism and hyperphosphatemia in ESRD patients consists of either calcium- or aluminum-based phosphate binders and calcitriol administration. Unfortunately, this ""old generation"" therapy is not free of complications. This review paper suggests that new calcium- and aluminum-free phosphate binders, such as lanthanum carbonate, can be used to treat hyperphosphatemia and secondary hyperparathyroidism in ESRD patients.

Calcium acetate versus calcium carbonate in the control of hyperphosphatemia in hemodialysis patients

Hyperphosphatemia has an important role in the development of bone and mineral abnormalities in end-stage renal disease (ESRD). To compare the phosphorus binding power and the hypercalcemic effect of calcium acetate and calcium carbonate in hemodialysis patients. Crossover, randomized, double-blind study. A private hospital dialysis center. Fifty-two patients who were undergoing regular hemodialysis three times a week ([Ca++] dialysate = 3.5 mEq/L). Half of the patients were started on 5.6 g/day of calcium acetate and, after a 2 week washout period, received 6.2 g/day of calcium carbonate. The other half followed an inverse protocol. Clinical interviews were conducted 3 times a week to monitor for side effects. Determinations of serum urea, calcium, phosphorus, hematocrit, Kt/V and blood gas analysis were obtained before and after each treatment. Twenty-three patients completed the study. A significant increase in calcium plasma levels was only observed after treatment with calcium carbonate [9.34 mg/dl (SD 0.91) vs. 9.91 mg/dl (SD 0.79), P < 0.01]. The drop in phosphorus levels was substantial and significant for both salts [5.64 mg/dl (SD 1.54) vs. 4.60 mg/dl (SD 1.32), P < 0.01 and 5.89 mg/dl (SD 1.71) vs. 4.56 mg/dl (SD 1.57), P < 0.01, for calcium acetate and calcium carbonate respectively]. The percentage reduction in serum phosphorus (at the end of the study) per milliequivalent of salt administered per day tended to be higher with calcium acetate but statistical significance was not found. Calcium acetate can be a good alternative to calcium carbonate in the handling of hyperphosphatemia in ESRD patients. When calcium acetate is used, control of hyperphosphatemia can be achieved with a lower administration of calcium, perhaps with a lower risk of hypercalcemia.