Serum Inorganic Phosphorus Levels Research Articles

A RETROSPECTIVE STUDY OF CORRELATION BETWEEN SERUM CREATININE, SERUM CALCIUM, SERUM INORGANIC PHOSPHORUS AND SERUM MAGNESIUM LEVELS IN PATIENTS ATTENDING NEPHROLOGY CLINICS IN TERTIARY CARE CENTER

Introduction: Chronic kidney disease (CKD) has been recognized as a leading public health problem worldwide. The global estimated prevalence of CKD is 13.4%. Kidney plays a critical role in regulating serum levels of Calcium, Magnesium and Phosphate. Calcium, phosphorus and magnesium homeostasis is altered in chronic kidney disease(CKD). Objective Objective: of the study is to establish the correlation of increase in serum creatinine levels with Calcium, Magnesium and Phosphate levels in patients. Design & Methods: This observational retrospective study included patients attending nephrology department in tertiary care centre for a period of two months. In total, 229 patients' data was accessed from the medical records. Patients were grouped in 5 groups based on serum Results: creatinine levels. Group I with serum creatinine levels of 0.5mg/dl to 0.8mg/dl, group II with serum creatinine levels of 0.8 to 1.1mg/dl, group III with serum creatinine levels of 1.1 to 3mg/dl, group IV with serum creatinine levels of 3 to 6mg/dl, group V with serum creatinine levels above 6mg/dl. Overall from group I to Group V , Serum Calcium showed negative and signicant correlation, Serum phosphorus levels showed positive and signicant correlation, Serum magnesium showed negative and insignicant correlation with serum creatinine. As Conclusions: serum creatinine increases, more patients show decline in serum calcium levels and serum magnesium levels and increase in serum inorganic phosphorus levels. Hypocalcemia, hypomagnesemia and hyperphosphatemia have been associated with increased risk of cardiovascular morbidity and mortality in cases of CKD. Hypomagnesemia has possible association with rapid decline in kidney function. Therefore, regular analysis of these parameters is important for predicting the prognosis of CKD and cardiovascular risk in cases of CKD.

USE OF SOME MEDICAMENTS IN THE TREATMENT OF AFFECTED CALVES WITH HYPOMAGNESAEMIC TETANY

This trial comprised (28) naturally affected calves with hypomagnesaemic tetany, which were diagnosed clinically and by measuring the serum level of magnesium, calcium, sodium, inorganic phosphorus, potassium and SGOT & CPK enzymes. There were significant decrease (P<0.01) in serum level of magnesium and calcium. While serum potassium and serum enzymes level shown significant increase (P < 0.01) during tetanic attacks. On the other hand serum sodium and inorganic phosphorus level were dropped slightly. Each calf was treated for three successive days with magnesium and calcium salts, with tranquilizers, in addition to sodium chloride for relief of dehydration. With the use of these medicaments as compared to the commerical preparations, the frequency of tetanic attacks decreased gradually then disappeared completely after the completion of treatment.

Clinico-Biochemical, Rumen Function and Histopathological Investigations of Trichobezoars in Sheep

Twenty-five out of 200 mature Barki ewes were diagnosed with trichobezoars over two years in a privately owned sheep farm. Diagnosed ewes showed signs of inappetence, dullness, emaciation, weakness, scanty hard feces, and recurrent bouts of tympany. Closer observation of these ewes revealed the abnormal behavior of wool pulling by teeth from each other. Serum copper, zinc, iron, glucose, total protein, albumin, globulins, calcium, inorganic phosphorus, sodium, potassium, and total cholesterol levels were significantly (P < 0.05) lower in ewes affected by trichobezoars than healthy ewes. In contrast, mean values of AST, ALT, total bilirubin, blood urea, and creatinine were significantly (P < 0.05) elevated in affected ewes. Furthermore, ruminal fluid analysis of trichobezoars ewes revealed a significant (P < 0.05) decrease in pH, total protozoa counts with reduced motility, whereas a significantly (P < 0.01) prolonged methylene blue reduction time and elevated levels of total volatile fatty acids were observed. Histopathological changes in the trichobezoars-affected rumen revealed ballooning degeneration, leukocytic infiltration in the mucosal layer. Mucosal sloughing with a detachment of the stratified epithelium abomasum showed ulcerated surface with necrotic glandular epithelium and focal leukocytic infiltrations, in conclusion when trichobezoars accumulate in larger numbers, more significant sizes in the rumen and Abomasum can obstruct the gastrointestinal tract and increase mortality risks in sheep.

Association between Serum Inorganic Phosphorus Levels and Adverse Outcomes in Chronic Kidney Disease: The Fukushima CKD Cohort Study.

Objective Although an association between serum inorganic phosphorus levels and a poor prognosis has been noted in dialysis patients, these associations have been insufficiently reported in non-dialysis-dependent chronic kidney disease (NDD-CKD) patients. This study attempted to determine the association between serum inorganic phosphorus levels and adverse outcomes in Japanese NDD-CKD patients. Methods We investigated the relationships between serum inorganic phosphorus levels and adverse outcomes, such as kidney events, cardiovascular events, and all-cause death, in Japanese NDD-CKD patients using longitudinal data from the Fukushima CKD Cohort Study with a median follow-up period of 2.8 years. The study evaluated 822 patients with NDD-CKD enrolled between June 2012 and July 2014. A kidney event was defined as a combination of doubling of the baseline serum creatinine or end-stage renal disease. Cox regression was performed to analyze the relationships of the quartile of the serum inorganic phosphorus with kidney events, cardiovascular events, and all-cause death. Results The frequency of kidney events per 1,000 person-years exhibited a U-shaped distribution based on serum inorganic phosphorus levels, with these levels not significantly associated with an increased risk of cardiovascular events and all-cause death. A multivariable Cox regression analysis showed an increased risk of kidney events for the highest quartile of the serum inorganic phosphorus levels (≥3.7 mg/dL) versus the second quartile (2.9-3.2 mg/dL, hazard ratio, 3.30; 95% confidence interval, 1.50-7.28; p=0.003). There were no significant associations between the serum calcium levels and adverse outcomes. Conclusion Serum inorganic phosphorus levels were associated with an increased risk of CKD progression in Japanese NDD-CKD patients.

Hydroxy-Safflower Yellow A Alleviates Osteoporosis in Ovariectomized Rat Model by Inhibiting Carbonic Anhydrase 2 Activity.

Background: To investigate the therapeutic effect of Hydroxy-safflower yellow A (HSYA) on rat’s osteoporosis and explore its potential mechanism of action. Methods: Bilateral ovariectomized female rats (OVX) were used to establish a postmenopausal rat model of osteoporosis. HSYA was given as an intervention, and estradiol was used as a positive control. The levels of serum alkaline phosphatase (ALP), calcium ion (Ca2+), and inorganic phosphorus (IP) were used to detect bone loss. Three months after modeling, the rats were sacrificed and the rat’s ovaries, kidneys, tibia, and femur were used to calculate the organ index. The bone marrow of the femur of the rats was stained with Giemsa staining. The femur strength of rats was measured by INSTRON. The degree of osteoporosis was detected by pathological staining after decalcification of bone tissue. Predicted the main targets of HSYA in combination with bioinformatics, and the proteins related to osteoclast differentiation were detected in combination with western blotting. The effect of HSYA on the differentiation of RAW264.7 cells into osteoclasts was observed. Results: The Giemsa staining and serum test results showed that the operation was successful and affected bone metabolism. In the bone strength test, HSYA significantly increased the maximum threshold of femoral load in rats. Pathological examination showed that tibial cartilage, trabecular bone, and cortex significantly increased after treatment with HYSA. The number of osteoblasts increased while the number of osteoclasts decreased—elevated levels of type I and III collagen. Autodock was used for molecular docking of potential targets of HSYA. qPCR and western blot were used to show that the expression levels of CA2 and osteoclast differentiation-related proteins were significantly decreased after HSYA treatment. Cell level results showed that HSYA could inhibit the activity of osteoclasts and the ability of RAW264.7 cells to differentiate into osteoclasts. Conclusion: HSYA can inhibit the differentiation and formation of osteoclasts by inhibiting the expression of CA2 and relieving osteoporosis symptoms in OVX rats.

Efficacy and safety of elobixibat in hemodialysis patients with chronic constipation: a retrospective study

BackgroundHemodialysis patients are likely to develop constipation as a complication due to food and fluid restrictions. Elobixibat is a new laxative that inhibits the ileal bile acid transporter expressed in the terminal ileum, suppresses bile acid reabsorption, increases the amount of bile acid flowing into the colon lumen, and promotes water secretion in the colon and colon motility. In this study, we examined the efficacy and safety of elobixibat in maintenance hemodialysis patients with chronic constipation.MethodsIn a study conducted on maintenance hemodialysis patients with chronic constipation, comparisons were conducted retrospectively based on constipation symptoms such as the frequency of spontaneous bowel movements before elobixibat treatment and 12 weeks after the administration of elobixibat, as well as based on blood electrolyte levels.ResultsThe study was conducted on 23 patients, 19 of whom were subjected to treatment efficacy analysis. The frequency of spontaneous bowel movements was 2.0 ± 0.7 times/week before administration of elobixibat and reached 4.9 ± 2.3 times/week after 12 weeks of administration. The increase started after 1 week of treatment. Elobixibat treatment improved the constipation score (baseline, 10.4 ± 3.2; after 12 weeks, 5.7 ± 3.2), the Bristol Stool Form Scale (baseline, 2.2 ± 1.0; after 12 weeks, 4.2 ± 0.7), and patient satisfaction regarding defecation (baseline, 2.9 ± 0.9; after 12 weeks, 1.7 ± 1.1). The interdialytic weight gain (IDWG) was 5.68 ± 0.82% before initiation of treatment and decreased to 4.54 ± 1.34% after 12 weeks. The serum inorganic phosphorus (IP) levels were 5.68 ± 1.25 mg/dL and decreased to 4.93 ± 1.10 mg/dL after 12 weeks.ConclusionsElobixibat was effective in improving constipation symptoms in maintenance hemodialysis patients with chronic constipation. Elobixibat also improved dialysis-related laboratory test results, such as a decrease in serum IP levels and IDWG.Trial registrationUMIN Clinical Trials Registry, UMIN000037285, retrospectively registered

Surgical Outcomes of Subtotal Parathyroidectomy for Renal Hyperparathyroidism.

ObjectivesThe aim of this study was to evaluate the effectiveness of subtotal parathyroidectomy for patients with renal hyperparathyroidism.MethodsWe studied 25 patients with renal hyperparathyroidism who underwent subtotal parathyroidectomy from October 2002 to October 2017. We analyzed serum intact parathyroid hormone (iPTH), calcium, and inorganic phosphorus levels before and at multiple time points following surgery, and evaluated the surgical outcomes and complications.ResultsOf the 25 patients, 13 (52%) were male and 12 (48%) were female, and the mean age was 53.4±9.3 years. The mean duration of dialysis before parathyroidectomy was 156.8±79.5 months. Mean preoperative serum iPTH and calcium levels were 1,199.0±571.3 pg/mL and 10.5±1.0 mg/dL, respectively. At 6 months postoperatively, the mean iPTH and calcium levels decreased to 49.2±47.6 pg/mL (P<0.01) and 8.0±1.0 mg/dL (P<0.01), respectively. Recurrent hyperparathyroidism occurred in two patients: one subsequently underwent kidney transplantation and the other continued hemodialysis and maintained normal calcium levels. One patient developed postoperative permanent hypoparathyroidism.ConclusionSubtotal parathyroidectomy is a safe and effective surgical treatment for renal hyperparathyroidism.

Mineralized tissues in hypophosphatemic rickets.

Hypophosphatemic rickets is caused by renal phosphate wasting that is most commonly due to X-linked dominant mutations in PHEX. PHEX mutations cause hypophosphatemia indirectly, through the increased expression of fibroblast growth factor 23 (FGF23) by osteocytes. FGF23 decreases renal phosphate reabsorption and thereby increases phosphate excretion. The lack of phosphate leads to a mineralization defect at the level of growth plates (rickets), bone tissue (osteomalacia), and teeth, where the defect facilitates the formation of abscesses. The bone tissue immediately adjacent to osteocytes often remains unmineralized ("periosteocytic lesions"), highlighting the osteocyte defect in this disorder. Common clinical features of XLH include deformities of the lower extremities, short stature, enthesopathies, dental abscesses, as well as skull abnormalities such as craniosynostosis and Chiari I malformation. For the past four decades, XLH has been treated by oral phosphate supplementation and calcitriol, which improves rickets and osteomalacia and the dental manifestations, but often does not resolve all aspects of the mineralization defects. A newer treatment approach using inactivating FGF23 antibodies leads to more stable control of serum inorganic phosphorus levels and seems to heal rickets more reliably. However, the long-term benefits of FGF23 antibody treatment remain to be elucidated.

Relationship between the level of estrogen, calcium and phosphorus concentration in serum with benign paroxysmal positional vertigo

Objective:To investigate relationship between the level of estrogen, calcium and phosphorus concentration in serum with benign paroxysmal positional vertigo(BPPV). Method:A total of 84 patients with idiopathic BPPV were enrolled in the experimental group, including 32 non-menopausal women, 24 menopausal women, and 28 males; 83 healthy people without vertigo and vestibular disease were selected as the control group consisted with 32 non-menopausal women, 24 menopausal women and 27 males. The levels of estradiol, serum calcium and serum inorganic phosphorus were measured in all participants. The difference of estrogen level, serum calcium and serum inorganic phosphorus concentration between the experimental group and the control group was analyzed by t test. Result:The total number, age distribution and gender composition of the experimental group and the control group were basically paired, and the age difference was not statistically significant (P=0.71). The overall estrogen level in the experimental group was lower than that in the control group (P<0.01). Among them, the female group's estrogen level, menopausal female estrogen level and male estrogen level in the experimental group were lower than the control group (P<0.01); there was no significant difference in serum calcium and serum inorganic phosphorus concentration between the experimental group and the control group (P=0.55, 0.11, respectively). Conclusion:The decrease of estrogen level may be a risk factor for idiopathic BPPV. The relationship between serum calcium and serum inorganic phosphorus concentration and BPPV needs further study.

Determination of blood serum calcium, inorganic phoshorus and magnesium in different productive stages of holstein dairy cows

Introduction. The aim of this study was to determine and compare levels of blood serum calcium, inorganic phosphorus and magnesium in the peripartal period and during mid lactation in Holstein dairy cattle. Materials and Methods. Blood samples were collected from 12 cows in late pregnancy, 12 early lactation cows, and 12 mid lactation cows. Results and Conclusions. Serum calcium and inorganic phosphorus in blood of dairy cows in early and mid lactation were significantly lower compared to the values in the blood serum of dairy cows in late pregnancy, probably indicating the increased use of these macro elements by the mammary gland at the early stages of lactation. When the cows were in the lactation period, blood serum magnesium levels were significantly lower compared to the values of dairy cows during late pregnancy, probably indicating the increased use of magnesium by the dairy cows during lactation. The results show that the homeostasis of the macro elements examined in the blood of transition and mid lactation dairy cows was maintained, suggesting their adequate supply from alimentary sources.

The Clinical Features of Cystic Parathyroid Adenoma in Chinese Population: A Single-Center Experience.

Objective Cystic parathyroid adenoma is a rare cause of primary hyperparathyroidism, but its preoperative diagnosis and management remain inconclusive. Method We retrospectively identified patients with cystic parathyroid adenomas who underwent surgery at Peking Union Medical College Hospital. Results Patients with cystic parathyroid adenomas had higher serum intact parathyroid hormone and calcium levels, larger maximum tumor diameter, and lower serum inorganic phosphorus level than did those with solid adenomas. Patients with cystic adenomas were predominantly male, and hypercalcemic crisis and atypical adenomas were common. The accuracy of preoperative localization methodologies was lower in patients with cystic adenomas than in patients with solid adenomas. US-guided fine-needle aspiration was performed in 11 patients. In all patients, the iPTH level in cystic fluid was much higher than that in serum. No sign of recurrence was observed after a median follow-up of 39 months. Conclusions Cystic parathyroid adenomas may not be as rare as previously reported. FNA may be a safe and feasible localization methodology for patients with inconclusive preoperative localization methodologies. Close follow-up is necessary for patients with cystic parathyroid adenomas, which account for a substantial proportion of atypical adenoma cases.

Fibroblast growth factor 23 mRNA expression profile in chickens and its response to dietary phosphorus

In mammals, fibroblast growth factor 23 (FGF23) regulates phosphate homeostasis in kidney by binding α-Klotho, a coreceptor of FGF23. FGF23 mRNA is highly expressed in bone and slightly expressed in liver, and is regulated by dietary phosphorus. Little is known about distribution and regulation of FGF23 mRNA in avian lineage. The expression of FGF23 and its coreceptor α-Klotho in chicken and embryo were investigated by real-time quantitative PCR. The effect of dietary phosphorus on FGF23 expression was measured. 36 laying hens at 25 wk were randomly assigned to three dietary available phosphorus (AP) treatments for 11 days: 0.15% AP (LP), 0.40% AP (MP), and 0.80% AP (HP). We first cloned the full coding sequence of FGF23 by the reverse transcription PCR from chicken liver and calvaria. Bioinformatics analysis indicated that the deduced amino acid sequence was 57-87% identical to FGF23 of other species. In adult chicken FGF23 mRNA was expressed at unexpected higher level in liver than other tissues evaluated, including calvaria, femur, tibia, medullary bone, brain, spleen, duodenum, jejunum, ileum, heart and kidney (P < 0.0001), and α-Klotho was expressed at highest level in kidney. However, in 18-d chicken embryos, FGF23 mRNA level was much higher in tibia than in liver, heart and jejunum (P < 0.0001). Chickens at 2, 25, 50 and 80 wk had higher FGF23 expression in liver than 18-d chicken embryos, whereas chickens at 25 wk had lower FGF23 expression in tibia than 18-d chicken embryos and 2-wk-old chickens. HP diets significantly increased serum inorganic phosphorus level (P < 0.001) and FGF23 expression (P < 0.05) in bone tissue compared with LP diets, however, FGF23 mRNA abundance in liver was not changed significantly (P > 0.05) by dietary phosphorus treatments. In conclusion, FGF23 mRNA expression pattern in chicken was clearly different from that in mammals and dietary phosphorus regulated the expression of FGF23 in a tissue-specific way.

Association of Phosphocalcic Metabolism and Body Condition Score after Parturition in High Producing Dairy Cows

The aim of the present study was to investigate the relationship between different body condition scores and phosphocalcic metabolism during the postpartum period in high producing dairy cows. Fifty seven multiparous Holstein dairy cows were used in the present study. Blood samples were collected at calving and at one and two month of postpartum to measure serum calcium and inorganic phosphorus levels. The BCS was monitored monthly after calving. Cows with body condition scores less than three does not mobilise their phosphocalcic reserve, they showed an hypocalcemia and there was a significant (P < 0.05) fall in serum inorganic phosphorus levels from 88mg / l at calving at rate to 63mg / l in the second month of post partum. In conclusion, among the different indices defined by the phosphocalcic metabolism measurements and BCS in the present study, the lower BCS and stress metabolic were the main factors associated with phosphocalcic metabolism distrubance in high producing dairy cows.

Effects of diisononyl phthalate on osteopenia in intact mice

Osteopenia is characterized by bone loss and deterioration of trabecular bone, which leads to osteoporotic fractures. This disease is highly prevalent in industrialized areas and is associated with exposure to endocrine disrupting chemicals (EDCs). Diisononyl phthalate (DINP) is one of these EDCs and is mainly used as a plasticizer in flexible polyvinyl chloride (PVC) products. Although it is well known that exposure to DINP is harmful to humans, no studies have been reported concerning its contribution to osteopenia. Therefore, in this study, we injected DINP (2, 20, and 200mg/kg) into C3H/HeN mice for 6weeks and found that the uterus weight, bone (femur and tibia) weight, and bone length of the DINP-exposed mice were reduced compared to those of the SHAM group. On the other hand, body weight, the serum alkaline phosphatase (ALP) and inorganic phosphorus (IP) levels in the DINP treated mice were increased compared with those of the SHAM group. The tartrate-resistant acid phosphatase (TRAP) activity (bone resorption marker) was increased and the bone alkaline phosphatase (BALP) activity was lowered by the treatment with DINP as compared with the SHAM group. Furthermore, the microarchitecture of the femur and tibia in the intact mice was destroyed by the DINP injection. The tissue volume (TV), bone volume (BV), BV/TV, bone surface (BS), BS/TV, trabecular thickness (Tb.Th), and trabecular number (Tb.N) were reduced and the trabecular pattern factor (Tb.Pf), structure model index (SMI), and trabecular separation (Tb.Sp) were increased by the DINP injection. The bone mineral density (BMD) of the femur and tibia was lower in the DINP group than in the SHAM group. These results indicate that DINP contributes to an increased risk of osteopenia via destruction of the microarchitecture and enhancement of osteoclast activity.

Serum Biochemical Profile In Normally Calved and Retained Foetal Membranes Crossbred Cows

Serum biochemical profile revealed that the serum calcium, inorganic phosphorus, total protein and serum glucose in cross-bred cows were significantly (P less than 0.05) lower after 12 hrs post-partum and 7th day post-partum in cows having RFM as compared to normally calved cows. Lower levels of serum calcium, inorganic phosphorus, total protein and glucose may responsible for retention of foetal membranes.

Primary hyperparathyroidism: insights from the Indian PHPT registry.

The presentation of primary hyperparathyroidism (PHPT) is variable throughout the world. The present study explored retrospective data submitted to the Indian PHPT registry ( http://www.indianphptregistry.com ) between July 2005 and June 2015 from 5 centres covering four different geographical regions. The clinical, biochemical, radiological and histopathological characteristics of PHPT patients across India were analysed for similarity and variability across the centres. A total of 464 subjects (137 men and 327 women) with histopathologically proven PHPT were analysed. The mean age was 41±14years with a female:male ratio of 2.4:1. The majority (95%) of patients were symptomatic. Common clinical manifestations among all the centres were weakness and fatigability (58.7%), bone pain (56%), renal stone disease (31%), pancreatitis (12.3%) and gallstone disease (11%). Mean serum calcium, parathyroid hormone and inorganic phosphorus levels were 11.9±1.6mg/dL, 752.4±735.2pg/mL and 2.8±0.9mg/dL, respectively. Sestamibi scanning had better sensitivity than ultrasonography in the localisation of parathyroid adenoma; however, when these two modalities were combined, 93% of the cases were correctly localised. Mean parathyroid adenoma weight was 5.6±6.5g (0.1-54g). It was concluded that the majority of PHPT patients within India are still mainly symptomatic with >50% of patients presenting with bone disease and one-third with renal impairment. Compared to Western countries, Indian patients with PHPT are younger, biochemical abnormalities are more severe, and adenoma weight is higher. As our observation is largely derived from a tertiary care hospital (no routine screening of serum calcium level), the results do not reflect racial differences in susceptibility to PHPT.

Effect of Aegle marmelos and Murraya koenigii in treatment of delayed pubertal buffaloes heifers.

Aim:This study aims to study the estrus induction, ovulation, and conception rate of delayed puberty in buffaloes heifers by feeding a herbal plants Aegle marmelos (bael/bili/bhel leaf) and Murraya koenigii (Curry leaf).Materials and Methods:Totally, 24 buffalo heifers with delayed puberty were selected for the present study and divided randomly in four equal groups (n=6). Before experiment, all animals were dewormed with albendazole at 10 mg/kg body weight to prevent them from the stress of parasitism. In the present experiment, four group taken and Group I (n=6) treated with A. marmelos, Group II (n=6) treated with M. koenigii, Group III (n=6) treated with mixture of A. marmelos and M. koenigii and fed for 9 days. Group IV (n=6) considered as control and fed with concentrate only. The blood samples were collected from all the animals on day 0 (before treatment), 4, 9 (during treatment), on the day of estrus and day 8 after the onset of estrus. The 10 ml blood was collected from the jugular vein of all the experimental animals for estimation of serum calcium, inorganic phosphorus, and progesterone (P4). The estrus response, ovulation, conception rate along with serum calcium, inorganic phosphorus, and progesterone level were determined by the standard protocol.Results:From Group III 4 heifers, from Group II 3 heifers, and from Group I and IV (Control) 2 heifers each, exhibited the estrus. The estrus response was recorded as 33.33%, 50.00%, 75.00%, and 33.33% in Group I, Group II, Group III, and Group IV, respectively. In treatment Group III, serum calcium found significantly more (p<0.05) on day 8 post-estrus as compared to other groups at a similar interval. Inorganic phosphorus and progesterone show no significant difference between groups. The ovulation and conception rates are comparatively better in Group III (75%) buffalo heifers than other groups.Conclusion:Herbal supplementation of A. marmelos and M. koenigii in combination, as well as M. koenigii alone, were found effective in fertility improvement in delayed pubertal buffalo heifers by increasing ovulation and conception rate.

Influence of proton pump inhibitors and histamine H2 receptor antagonists on serum phosphorus level control by calcium carbonate in patients undergoing hemodialysis: a retrospective medical chart review.

BackgroundHyperphosphatemia is one of the common complications in patients undergoing hemodialysis. Although calcium carbonate (CaC) is often used to control serum inorganic phosphorus level in dialysis patients, co-administration of gastric acid reducers (ARs) may interfere with the phosphate binding effect of CaC. We performed a retrospective medical chart review to study whether ARs attenuate the hypophosphatemic effect of CaC in patients undergoing hemodialysis.MethodsOne hundred and eight chronic hemodialysis patients receiving either CaC alone or CaC concomitant with one of the ARs (proton pump inhibitors and histamine H2-receptor antagonists) were retrieved from the medical charts in Juntendo University Nerima Hospital. The patients were subdivided according to the interval between hemodialysis sessions (interdialysis interval of 48 or 72 h). A multivariate analysis was performed to identify clinical covariates associated with the variability of serum inorganic phosphorus levels. The study protocol was approved by the Institutional Review Board before the study was begun.ResultsAmong patients on hemodialysis with a 72-h interdialysis interval, the magnitude of increase in serum inorganic phosphorus concentration in patients receiving CaC and AR was significantly greater than in those receiving CaC alone. While a similar trend was observed among patients with a 48-h interdialysis interval, the difference did not reach a significant level. A multivariate regression analysis revealed that concomitant administration of ARs with CaC and a longer interdialysis interval (72 h) were significantly and independently associated with the magnitude of increase in serum phosphorus concentration between dialysis sessions. No significant differences in albumin-corrected serum calcium concentrations and incidence of pathological fractures were observed between patients receiving CaC alone and those receiving CaC with ARs.ConclusionsConcomitant use of ARs with CaC may attenuate the hypophosphatemic effect of CaC in patients undergoing chronic hemodialysis. When hemodialysis patients require prescription of ARs for the prevention of upper gastrointestinal mucosal diseases (such as peptic ulcer), it may be prudent to choose a phosphate binder other than CaC.

Incidence of hypophosphatemia in advanced cancer patients: a recent report from a single institution

Recent approval of molecular-targeted agents has contributed to improving the therapeutic outcomes of advanced cancer patients. However, they result in unusual adverse events that rarely occur with cytotoxic agents, such as hypertension, hypomagnesemia, and an acne-like rash. Although hypophosphatemia can be induced by various agents, some kinds of molecular-targeted agents are known to induce it. In addition, cancer survivors may be at a risk of hypophosphatemia. One hundred and seventy patients, who visited the Department of Clinical Oncology at Akita University from 1 April 2014 to 31 August 2016 were enrolled in this study after providing informed consent. Serum inorganic phosphorus levels were examined along with other routine clinical examinations. Correlation between the serum inorganic phosphorus level and other clinical data were also analyzed. Grade ≥2 severe hypophosphatemia (<2.5mg/dL of phosphorus) was detected in 49.4% of patients, and grade ≥3 (<2.0mg/dL of phosphorus) was observed in 22.9% patients. These results indicated that the presence of bone metastasis (p<0.001), history of bone-modifying agents (p<0.001) and molecular-targeted drugs (p=0.001), and time from the date of the first visit to the date of minimum serum phosphorus level (p<0.001) might correlate with hypophosphatemia. Multivariate logistic regression analysis showed that disease duration might be a risk factor (p=0.0466). As hypophosphatemia can be induced by various factors in advanced cancer patients, the serum phosphorus level of cancer patients at risk should be cautiously examined.

Lubiprostone, a novel laxative, might improve hyperphosphatemia without water dilution

Hemodialysis patients often develop constipation due to dietary restriction and the use of phosphate and/or potassium binders. Lubiprostone is a novel laxative that promotes defecation by activating the chloride ion channel 2 (ClC-2) in the gastrointestinal tract. While lubiprostone has been reported to be useful in bowel control of dialysis patients, no studies have examined changes in electrolyte levels following administration of lubiprostone. We prospectively compared stool frequency and electrolyte levels before and after treatment with lubiprostone in 28 hemodialysis patients treated with the drug for at least 3 months in our hospital. Mean ± standard deviation of stool frequency was significantly increased from 1.8 ± 1.3 times/week before treatment to 4.3 ± 1.8 times/week at Month 1, 4.9 ± 1.9 times/week at Month 2, and 4.5±1.5 times/week at Month 3 (p < 0.001, p < 0.001, and p < 0.001, respectively). With regard to electrolyte levels, only serum inorganic phosphorus (IP) level was significantly decreased, from 4.7 ± 1.5 mg/dL at baseline to 4.5 ± 1.6 mg/dL at Month 1, 4.0 ± 1.3 mg/dL at Month 2, and 3.8 ± 1.1 mg/dL at Month 3 (p = 0.123, p < 0.001, and p < 0.001, respectively). Lubiprostone not only improved bowel control, but also decreased serum IP levels in hemodialysis patients. Lubiprostone may improve prognosis of hemodialysis patients through bowel control and a decrease in serum IP.