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Kendrick JB, Zhou M, Ficociello LH, Parameswaran V, Mullon C, Anger MS, Coyne DW. Serum Phosphorus and Pill Burden Among Hemodialysis Patients Prescribed Sucroferric Oxyhydroxide: One-Year Follow-Up on a Contemporary Cohort. Int J Nephrol Renovasc Dis 2022; 15:139-149. [PMID: 35431567 PMCID: PMC9012313 DOI: 10.2147/ijnrd.s353213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/19/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose In prior analyses of real-world cohorts of hemodialysis patients switched from one phosphate binder (PB) to sucroferric oxyhydroxide (SO), SO therapy has been associated with improvements in serum phosphorus (sP) and reductions in daily PB pill burden. To characterize how SO initiation patterns have changed over time, we examined the long-term effectiveness of SO in a contemporary (2018–2019) cohort. Patients and Methods Adult Fresenius Kidney Care hemodialysis patients first prescribed SO monotherapy as part of routine care between May 2018 and May 2019 (N = 1792) were followed for 1 year. All patients received a non-SO PB during a 91-day baseline period before SO prescription. Mean PB pills/day and laboratory parameters were compared before and during SO treatment. Results were divided into consecutive 91-day intervals (Q1–Q4) and analyzed using linear mixed-effects regression and Cochran’s Q test. These results were contrasted with findings from a historical (2014–2015) cohort (N = 530). Results The proportion of patients achieving sP ≤5.5 mg/dl increased after switching to SO (from 27.0% at baseline to 37.8%, 45.1%, 44.7%, and 44.0% at Q1, Q2, Q3, and Q4, respectively; P < 0.0001 for all). The mean daily PB pill burden decreased from a baseline of 7.7 to 4.4, 4.6, 4.8, and 4.9, respectively, across quarters (P < 0.0001 for all). Patients in the contemporary cohort had improved sP control (27.0% achieving sP ≤5.5 mg/dl vs 17.7%) and lower daily PB pill burden (mean 7.7 vs 8.5 pills/day) at baseline than those in the historical cohort. Overall use of active vitamin D was similar between cohorts, although higher use of oral active vitamin D (63.9% vs 15.7%) and lower use of IV active vitamin D lower (23.4% vs 74.2%) was observed in the contemporary cohort. Conclusion Despite evolving treatment patterns, switching to SO resulted in improved sP control with fewer pills per day in this contemporary hemodialysis cohort.
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Affiliation(s)
| | - Meijiao Zhou
- Fresenius Medical Care Global Medical Office, Waltham, MA, USA
| | | | | | - Claudy Mullon
- Fresenius Medical Care Global Medical Office, Waltham, MA, USA
| | - Michael S Anger
- Fresenius Medical Care Global Medical Office, Waltham, MA, USA
- Unversity of Colorado School of Medicine, Denver, CO, USA
| | - Daniel W Coyne
- Washington University School of Medicine, St. Louis, MO, USA
- Correspondence: Daniel W Coyne, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA, Tel +1 314-362-7603, Fax +1 314-747-5213, Email
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Uwitonze AM, Rahman S, Ojeh N, Grant WB, Kaur H, Haq A, Razzaque MS. Oral manifestations of magnesium and vitamin D inadequacy. J Steroid Biochem Mol Biol 2020; 200:105636. [PMID: 32084549 DOI: 10.1016/j.jsbmb.2020.105636] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 12/04/2019] [Accepted: 02/17/2020] [Indexed: 12/11/2022]
Abstract
Adequate nutrition is essential for maintaining good oral health. Minerals such as magnesium, calcium, and phosphorus found in the diet constitute the main structural components of the tooth. Their inadequacy leads to absorption impairment, increased bleeding tendency, bone resorption, looseness, and premature tooth loss. Inadequacy of those essential minerals is associated with delayed tooth eruption and with enamel or dentin hypoplasia. Taking calcium without magnesium results in soft dental enamel, which cannot resist the acids causing tooth decay. In addition to magnesium, calcium, and phosphorus, adequate vitamin D is needed to maintain optimal oral health. Vitamin D exerts anti-inflammatory effects and helps in calcium absorption and bone remodeling. Moreover, adequate vitamin D status could reduce formation of dental caries by delaying its onset and progression. Here we summarize the oral manifestations of vitamin D and magnesium inadequacy.
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Affiliation(s)
- Anne Marie Uwitonze
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda
| | - Sayeeda Rahman
- Department of Pharmacology & Public Health, School of Medicine, American University of Integrative Sciences, Bridgetown, Barbados
| | - Nkemcho Ojeh
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - William B Grant
- Sunlight, Nutrition, & Health Research Center, San Francisco, CA, USA
| | - Harleen Kaur
- Department of Computer Science & Engineering, School of Engineering Sciences & Technology, Jamia Hamdard, New Delhi, India
| | - Afrozul Haq
- Department of Food Technology, School of Interdisciplinary Sciences, Jamia Hamdard, New Delhi, India
| | - Mohammed S Razzaque
- Department of Preventive & Community Dentistry, University of Rwanda College of Medicine & Health Sciences, School of Dentistry, Kigali, Rwanda; College of Advancing & Professional Studies (CAPS), University of Massachusetts Boston (UMB), Boston, MA, USA; Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
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3
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Yaguchi A, Akahane K, Tsuchioka K, Yonekubo S, Yamamoto S, Tamai Y, Tatemichi S, Takeda H. A comparison between the combined effect of calcium carbonate with sucroferric oxyhydroxide and other phosphate binders: an in vitro and in vivo experimental study. BMC Nephrol 2019; 20:465. [PMID: 31830936 PMCID: PMC6909506 DOI: 10.1186/s12882-019-1655-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023] Open
Abstract
Background Approximately 30% of patients on dialysis received combination therapy for their phosphate binder prescription; however, few studies for combined effects of phosphate binders are reported. For the purpose of evaluating the efficacy of combination therapy, we compared the efficacy of sucroferric oxyhydroxide (PA21) combined with calcium carbonate with that of lanthanum carbonate hydrate, sevelamer hydrochloride, and ferric citrate hydrate combined with calcium carbonate. Methods For in vitro studies, calcium carbonate and the other phosphate binders alone or in combination were stirred in phosphate solution at pH 2–8 for 2 h. After centrifuging the suspension, the phosphorus level in the supernatant was determined. For in vivo studies, rats were orally administered calcium carbonate and the other phosphate binders (except for sevelamer hydrochloride) alone or in combination, followed by oral administration of phosphate solution adjusted to pH 2 or 7. Serum samples were collected from the rats at predetermined timepoints and the serum phosphorus levels were determined and analyzed using a two-way analysis of variance. Results In the in vitro study, the measured phosphate-binding capacity of combining sevelamer hydrochloride, PA21, and lanthanum carbonate hydrate with calcium carbonate was approximately equal to or greater than the theoretical values under most conditions. Furthermore, these combined effects were insensitive to pH in that order. The measured phosphate-binding capacity of ferric citrate hydrate combined with calcium carbonate was smaller than the theoretical values, and the combination did not exhibit efficacy under any of the tested conditions. In the in vivo study, the combined effect of PA21 and calcium carbonate at both pH values and that of lanthanum carbonate hydrate and calcium carbonate at pH 2 were additive. In contrast, the combined effect of lanthanum carbonate hydrate and calcium carbonate at pH 7 and that of ferric citrate hydrate and calcium carbonate at pH 2 were antagonistic. Conclusions These results suggest that coadministration of PA21 and calcium carbonate showed good and relatively stable efficacy throughout the range of the gastrointestinal pH and that combining lanthanum carbonate hydrate and ferric citrate hydrate with calcium carbonate may not produce the expected efficacy under certain conditions.
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Affiliation(s)
- Atsushi Yaguchi
- Pharmacology Research Group, Pharmacology and Pharmacokinetics Research Laboratory, R&D, Kissei Pharmaceutical Co., Ltd., 4365-1 Kashiwabara, Hotaka, Azumino, Nagano, 399-8304, Japan.
| | - Kenji Akahane
- Pharmacology Research Group, Pharmacology and Pharmacokinetics Research Laboratory, R&D, Kissei Pharmaceutical Co., Ltd., 4365-1 Kashiwabara, Hotaka, Azumino, Nagano, 399-8304, Japan
| | - Kumi Tsuchioka
- Pharmacology Research Group, Pharmacology and Pharmacokinetics Research Laboratory, R&D, Kissei Pharmaceutical Co., Ltd., 4365-1 Kashiwabara, Hotaka, Azumino, Nagano, 399-8304, Japan
| | - Saori Yonekubo
- Pharmacology Research Group, Pharmacology and Pharmacokinetics Research Laboratory, R&D, Kissei Pharmaceutical Co., Ltd., 4365-1 Kashiwabara, Hotaka, Azumino, Nagano, 399-8304, Japan
| | - Shota Yamamoto
- Pharmacology Research Group, Pharmacology and Pharmacokinetics Research Laboratory, R&D, Kissei Pharmaceutical Co., Ltd., 4365-1 Kashiwabara, Hotaka, Azumino, Nagano, 399-8304, Japan
| | - Yasuaki Tamai
- Pharmacology Research Group, Pharmacology and Pharmacokinetics Research Laboratory, R&D, Kissei Pharmaceutical Co., Ltd., 4365-1 Kashiwabara, Hotaka, Azumino, Nagano, 399-8304, Japan
| | - Satoshi Tatemichi
- Pharmacology Research Group, Pharmacology and Pharmacokinetics Research Laboratory, R&D, Kissei Pharmaceutical Co., Ltd., 4365-1 Kashiwabara, Hotaka, Azumino, Nagano, 399-8304, Japan
| | - Hiroo Takeda
- Pharmacology Research Group, Pharmacology and Pharmacokinetics Research Laboratory, R&D, Kissei Pharmaceutical Co., Ltd., 4365-1 Kashiwabara, Hotaka, Azumino, Nagano, 399-8304, Japan
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Parker K, Wong J. Is polypharmacy an increasing burden in chronic kidney disease? The German experience. Clin Kidney J 2019; 12:659-662. [PMID: 31584570 PMCID: PMC6768297 DOI: 10.1093/ckj/sfz072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Indexed: 02/07/2023] Open
Abstract
This is a commentary article describing the key findings of the German chronic kidney disease (GCKD) study and how these relate to current practice. With the GCKD study showing high levels of polypharmacy, this article discusses ways to ensure that polypharmacy is appropriate and the difficulties faced within a chronic kidney disease population. Suggestions of ways to minimize medication burden in renal patients provide some practical advice for clinicians.
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Affiliation(s)
- Kathrine Parker
- Department of Pharmacy, Manchester University NHS Foundation Trust, Manchester, UK
| | - Joanne Wong
- Department of Pharmacy, Manchester University NHS Foundation Trust, Manchester, UK
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Lin WJ, Lee SA. A novel iron-conjugated acid-modified chitosan derivatives as an oral phosphate binding agent to improve phosphorus adsorption efficacy in vitro and in vivo, synthesis and their characterization. Carbohydr Polym 2019; 212:378-386. [PMID: 30832870 DOI: 10.1016/j.carbpol.2019.02.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/19/2023]
Abstract
Current phosphate binders used for hyperphosphatemia treatment need large daily dose which make patients' compliance worse and the therapeutic efficacy may not conform the expectation. In this study, three polyacid modified iron-based chitosan derivatives were developed as an oral phosphate binding agent to improve phosphorus adsorption efficacy. The result showed that modification of chitosan by citric acid (CA) could facilitate the conjugation of iron by two folds (272.0 ± 12.1-315.3 ± 20.5 mg Fe/g vs. 141.0 ± 4.9-156.5 ± 8.3 mg Fe/g). All of these iron-based acid-modified chitosan had acceptable safety with cell viability >75% in the concentration up to 250 μg/mL. The stability in terms of iron release in pH 1.0 for 2 h was in the order of DPCS-NAc-CA-Fe (8.9 ± 2.3%) < DPCS-CA-Fe (19.1 ± 4.1%) < DADPCS-CA-Fe (24.6 ± 2.6%) indicating DPCS-NAc-CA-Fe was the most stable one. These iron-based acid-modified chitosan derivatives efficiently adsorbed 255.7 ± 11.3-271.2 ± 19.3 mg of phosphate especially in simulated gastro pH 1.0 in vitro. Furthermore, oral administration of DPCS-NAc-CA-Fe significantly lowered serum phosphorus level from 5.82 ± 0.45 mg/dL to 4.84 ± 0.56 mg/dL (p < 0.01) at 0.25% low feeding dose for 3 weeks without losing of weight, appetite, and activity of Wistar rats.
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Affiliation(s)
- Wen Jen Lin
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Drug Research Center, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Shu An Lee
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Desbrieres J, Peptu C, Ochiuz L, Savin C, Popa M, Vasiliu S. Application of Chitosan-Based Formulations in Controlled Drug Delivery. SUSTAINABLE AGRICULTURE REVIEWS 36 2019. [DOI: 10.1007/978-3-030-16581-9_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Rajah R, Eng MF, Tan SY. Impact of pharmacist‐led education sessions on the knowledge and practice of calcium carbonate administration among Malaysian chronic kidney disease patients. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Retha Rajah
- Seberang Jaya Hospital Seberang Jaya City Penang Malaysia
| | - May Fern Eng
- Seberang Jaya Hospital Seberang Jaya City Penang Malaysia
| | - Siao Yin Tan
- Seberang Jaya Hospital Seberang Jaya City Penang Malaysia
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Avila M, Mora C, Prado MDC, Zavala M, Paniagua R. Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients. Am J Nephrol 2017; 46:39-46. [PMID: 28614819 DOI: 10.1159/000477380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 03/27/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Arterial calcification (AC) is frequent in patients with end stage renal disease and is also considered a risk factor for later morbidity and mortality. However, long-term factors associated with the process are not well known. We analyzed the trends over time of biomarkers related with development and progression of AC in incident patients on peritoneal dialysis (PD). METHODS We performed a prospective study with 186 patients on PD followed up for 1 year. We analyzed the progression of AC in the abdominal aorta and pelvic vessels by calcification score (CaSc), using16-cut computerized multidetector tomography at baseline and 1 year. Variables related with PD treatment, inflammation, and mineral metabolism were measured at baseline, 6, and 12 months of follow-up. Changes in biochemical variables were analyzed for their relationship with changes in AC. RESULTS Over 1 year, the number of patients with AC increased from 47 to 56%, and CaSc from 355 (interquartile range [IQR] 75-792) to 529 (IQR 185-1632). A total of 43.5% of patients remained free of calcification, 11.7% had new calcifications, and 44.8% had progression of calcification. Older age, diabetes, high systolic blood pressure, body mass index, cholesterol, and osteoprotegerin (OPG), as well as lower levels of albumin, serum creatinine, and osteocalcin, were associated with development of new, and rapid progression of, calcification. In multivariate logistic analysis, OPG remained the most significant (OR 1.27, 95% CI 1.11-1.47, p < 0.001). CONCLUSION OPG was the strongest risk factor associated with new development and rapid progression of AC in incident PD patients.
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Affiliation(s)
- Marcela Avila
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN SXXI, Instituto Mexicano del Seguro Social, Mexico, Mexico
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9
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de Fornasari MLL, dos Santos Sens YA. Replacing Phosphorus-Containing Food Additives With Foods Without Additives Reduces Phosphatemia in End-Stage Renal Disease Patients: A Randomized Clinical Trial. J Ren Nutr 2017; 27:97-105. [DOI: 10.1053/j.jrn.2016.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022] Open
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10
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Gojaseni P, Pattarathitinan D, Chittinandana A. Efficacy of low-dose cinacalcet on alternate days for the treatment of secondary hyperparathyroidism in hemodialysis patients: a single-center study. Int J Nephrol Renovasc Dis 2017; 10:47-53. [PMID: 28223837 PMCID: PMC5304993 DOI: 10.2147/ijnrd.s124844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction Cinacalcet is effective in reducing serum parathyroid hormone (PTH) in patients with secondary hyperparathyroidism (HPT). This study focused on testing whether a prescription of low-dose cinacalcet on alternate days could be an option for treatment of secondary HPT. Materials and methods A retrospective clinical study was conducted on chronic maintenance hemodialysis patients. Patients with secondary HPT who received cinacalcet at a starting dose of 25 mg on alternate days were reviewed (low-dose group). Patients who were being treated with a standard dose of cinacalcet in the same period of time were selected as the control group. The primary outcome was difference in the percentage of patients achieving >30% reduction of intact parathyroid hormone (iPTH) levels at 16 weeks. The changes of serum iPTH and other biochemical data were also tested. Results A total of 30 patients (16 low doses and 14 controls) took part in the study. Baseline iPTH levels in the low-dose and control group were 1,065.9±477.7 and 1,214.1±497.6 pg/mL, respectively (p=0.413). The analysis showed that the percentage of patients who achieved the primary outcome showed little or no difference (33.3% in the low-dose group compared with 38.5% in the control group, p=1.0). Serum iPTH reduction during 16 weeks of study period in the low-dose and control group was 253.5±316.1 and 243.4±561.3 pg/mL, respectively (p=0.957). There was no difference in the adverse events between both groups. Conclusion Among patients with secondary HPT, initial treatment with cinacalcet 25 mg on alternate days can decrease serum PTH levels. The role of low-dose cinacalcet in secondary HPT should be further determined in large-scale, randomized controlled trials.
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Affiliation(s)
- Pongsathorn Gojaseni
- Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand
| | - Dolnapa Pattarathitinan
- Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand
| | - Anutra Chittinandana
- Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force, Bangkok, Thailand
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11
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Block GA, Rosenbaum DP, Leonsson-Zachrisson M, Åstrand M, Johansson S, Knutsson M, Langkilde AM, Chertow GM. Effect of Tenapanor on Serum Phosphate in Patients Receiving Hemodialysis. J Am Soc Nephrol 2017; 28:1933-1942. [PMID: 28159782 DOI: 10.1681/asn.2016080855] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/07/2016] [Indexed: 12/19/2022] Open
Abstract
Hyperphosphatemia is common among patients with CKD stage 5D and is associated with morbidity and mortality. Current guidelines recommend lowering serum phosphate concentrations toward normal. Tenapanor is a minimally absorbed small molecule inhibitor of the sodium/hydrogen exchanger isoform 3 that functions in the gut to reduce sodium and phosphate absorption. This randomized, double-blind, placebo-controlled trial assessed the effects of tenapanor on serum phosphate concentration in patients with hyperphosphatemia receiving hemodialysis. After a 1- to 3-week washout of phosphate binders, we randomly assigned 162 eligible patients (serum phosphate =6.0 to <10.0 mg/dl and a 1.5-mg/dl increase from before washout) to one of six tenapanor regimens (3 or 30 mg once daily or 1, 3, 10, or 30 mg twice daily) or placebo for 4 weeks. The primary efficacy end point was change in serum phosphate concentration from baseline (randomization) to end of treatment. In total, 115 patients (71%) completed the study. Mean serum phosphate concentrations at baseline (after washout) were 7.32-7.92 mg/dl for tenapanor groups and 7.87 mg/dl for the placebo group. Tenapanor provided dose-dependent reductions in serum phosphate level from baseline (least squares mean change: tenapanor =0.47-1.98 mg/dl; placebo =0.54 mg/dl; P=0.01). Diarrhea was the most common adverse event (tenapanor =18%-68%; placebo =12%) and frequent at the highest tenapanor doses. In conclusion, tenapanor treatment resulted in statistically significant, dose-dependent reductions in serum phosphate concentrations in patients with hyperphosphatemia receiving hemodialysis. Additional studies are required to clarify the optimal dosing of tenapanor in patients with CKD-related hyperphosphatemia.
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Affiliation(s)
| | | | | | | | | | | | | | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford, California
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Copland M, Komenda P, Weinhandl ED, McCullough PA, Morfin JA. Intensive Hemodialysis, Mineral and Bone Disorder, and Phosphate Binder Use. Am J Kidney Dis 2016; 68:S24-S32. [DOI: 10.1053/j.ajkd.2016.05.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/25/2016] [Indexed: 12/17/2022]
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13
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Yabuki K, Shiba E, Harada H, Uchihashi K, Matsuyama A, Haratake J, Hisaoka M. Lanthanum deposition in the gastrointestinal mucosa and regional lymph nodes in dialysis patients: Analysis of surgically excised specimens and review of the literature. Pathol Res Pract 2016; 212:919-926. [PMID: 27515549 DOI: 10.1016/j.prp.2016.07.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/22/2016] [Accepted: 07/31/2016] [Indexed: 02/08/2023]
Abstract
Lanthanum carbonate (LC) is one of the most potent phosphate binders currently used to reduce serum phosphate levels in dialysis patients with end-stage renal disease (ESRD). LC forms insoluble complexes with dietary phosphate that pass through the gastrointestinal (GI) tract with little absorption. GI lesions due to lanthanum deposition in biopsy specimens or those in endoscopic submucosal dissection (ESD) in dialysis patients have been recently identified. Here, we describe more detailed histopathological findings in the gastroduodenal mucosa and regional lymph nodes in three patients with gastric cancer. Three patients with ESRD, two elderly women and one man, underwent dialysis and were treated with LC for 3-36 months. The patients underwent laparoscopic distal gastrectomy and lymph node dissection due to gastric cancer. Many subepithelial histiocyte aggregates or small foreign body granulomas, which contained gray or brown pigments or crystal-like structures, were mostly present in non-neoplastic areas of the upper GI. Lanthanum accumulation was noted in the duodenal mucosa and the antral and body mucosae of the gastric lesser curvature. Lanthanum was also deposited in the regional lymph nodes of the three patients. Electron microscopy with energy dispersive X-ray spectroscopy confirmed lanthanum and phosphorus deposits in histiocytes. Long-term prognosis of patients and the excretion or the metabolic pathway of accumulated lanthanum remain unclear.
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Affiliation(s)
- Kei Yabuki
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
| | - Eisuke Shiba
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Hiroshi Harada
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Kazuyoshi Uchihashi
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Atsuji Matsuyama
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
| | - Joji Haratake
- Division of Pathology, Saiseikai Yahata General Hospital, 5-9-27 Harunomachi, Yahatanhigashi-ku, Kitakyushu 805-0050, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
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Greig SL, Plosker GL. Sucroferric oxyhydroxide: a review in hyperphosphataemia in chronic kidney disease patients undergoing dialysis. Drugs 2015; 75:533-42. [PMID: 25761962 DOI: 10.1007/s40265-015-0366-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sucroferric oxyhydroxide (Velphoro®), an iron-based oral phosphate binder, is available for the control of serum phosphorus levels in patients with chronic kidney disease (CKD) on dialysis. In a pivotal phase III trial, sucroferric oxyhydroxide 1000-3000 mg/day for 24 weeks was noninferior to sevelamer carbonate 4800-14,400 mg/day with regard to lowering serum phosphorus levels. Additionally, sucroferric oxyhydroxide at maintenance dosages was significantly more effective than low dosage sucroferric oxyhydroxide (250 mg/day) with regard to maintaining controlled serum phosphorus levels during weeks 24-27 of treatment. Sucroferric oxyhydroxide had a numerically lower mean daily pill burden and better treatment adherence than sevelamer carbonate. Treatment with sucroferric oxyhydroxide was generally well tolerated over 24 weeks' treatment, with the most frequently reported treatment-emergent adverse events being mild, transient diarrhoea and discoloured faeces. In a 28-week extension study, the efficacy and tolerability profile of sucroferric oxyhydroxide remained similar to sevelamer carbonate for up to 52 weeks. In conclusion, sucroferric oxyhydroxide is a valuable treatment option for hyperphosphataemia in CKD patients on dialysis, providing an effective and generally well tolerated noncalcium-based phosphate binder therapy with a lower pill burden than sevelamer carbonate and the potential for improved treatment adherence.
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Affiliation(s)
- Sarah L Greig
- Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand,
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Meyrier A. A farewell editorial from the Clinical Kidney Journal's former Editor-in-Chief. Clin Kidney J 2015; 7:505-6. [PMID: 25859364 PMCID: PMC4389138 DOI: 10.1093/ckj/sfu101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/08/2014] [Indexed: 12/16/2022] Open
Affiliation(s)
- Alain Meyrier
- Professor Emeritus of Medicine, Université Paris-Descartes and Hôpital Georges Pompidou (AP-HP), 75015, Paris, France
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Locatelli F, Del Vecchio L. Cardiovascular mortality in chronic kidney disease patients: potential mechanisms and possibilities of inhibition by resin-based phosphate binders. Expert Rev Cardiovasc Ther 2015; 13:489-99. [PMID: 25804298 DOI: 10.1586/14779072.2015.1029456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cardiovascular mortality has been considered as the most important risk associated with chronic kidney disease. The mechanisms underlying this include inflammation, poor control of serum phosphate, high serum calcium, increased calcification of the arteries and cardiac valves, hyperlipidemia, diabetes, severe anemia, uric acid accumulation and others. Elevated phosphate levels have been strongly associated with increased mortality, thus phosphate-binding drugs have long been used to control the increase serum phosphate levels. However, phosphate-binding drugs differ considerably and recently numerous publications suggest differences between agents in the effects on overall mortality. The resin-based phosphate binders, comprising sevelamer and colestilan, not only reduce serum phosphate but also do not raise serum calcium. In addition, they reduce serum LDL-C, inflammation, uric acid and high Hba1c values. These differences suggest that not all phosphate binders may be equal in the context of cardiovascular mortality in this patient population.
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Locatelli F, Dimkovic N, Spasovski G. Colestilan for the treatment of hyperphosphatemia in chronic kidney disease patients on dialysis. Expert Rev Endocrinol Metab 2015; 10:131-142. [PMID: 30293511 DOI: 10.1586/17446651.2015.1009368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Chronic kidney disease in the later stages poses many treatment challenges. Hyperphosphatemia is one that is well-known and is often linked to increased cardiovascular morbidity/mortality. Currently, a number of phosphate binders are available that act to conserve serum phosphate at normal or near normal levels. However, it is the overall profile of all binders that needs to be taken into account and the risks and the potential benefits associated with each agent must be balanced when selecting a particular phosphate binder. It is known that calcium-based binders, although effective phosphate binders, may lead to hypercalcemia and/or positive calcium balance and cardiovascular calcification. One, new non-calcium phosphate binder, recently approved in Europe, is colestilan. Colestilan possesses a range of properties that may afford further advantages over simply reducing serum phosphate. This review assesses the pharmacology and clinical data of colestilan used to treat hyperphosphatemia in chronic kidney disease stage 5 patients on dialysis. The article was written based on literature searches using PubMed to find articles published on phosphate binders or colestilan over the last 10 years.
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Affiliation(s)
- Francesco Locatelli
- a 1 Department of Nephrology Dialysis and Renal Transplantation, Alessandro Manzoni Hospital, Lecco, Italy
| | - Nada Dimkovic
- b 2 Medical Faculty University of Belgrade, Zvezdara University Medical Center, Belgrade, Serbia
| | - Goce Spasovski
- c 3 Department of Nephrology, Clinical Centre Skopje, Skopje, Macedonia
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Locatelli F, Dimkovic N, Spasovski G. Efficacy of colestilan in the treatment of hyperphosphataemia in renal disease patients. Expert Opin Pharmacother 2014; 15:1475-88. [DOI: 10.1517/14656566.2014.928285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Locatelli F, Del Vecchio L, Violo L, Pontoriero G. Phosphate binders for the treatment of hyperphosphatemia in chronic kidney disease patients on dialysis: a comparison of safety profiles. Expert Opin Drug Saf 2014; 13:551-61. [PMID: 24702470 DOI: 10.1517/14740338.2014.907791] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hyperphosphatemia is common in the late stages of chronic kidney disease (CKD) and is associated with elevated parathormone levels, abnormal bone mineralization, extraosseous calcification and increased risk of cardiovascular events and death. Several classes of oral phosphate binders are available to help control phosphorus levels. Although effective at lowering serum phosphorus, they all have safety issues that need to be considered when selecting which one to use. AREAS COVERED This paper reviews the use of phosphate binders in patients with CKD on dialysis, with a focus on safety and tolerability. In addition to the more established agents, a new resin-based phosphate binder, colestilan, is discussed. EXPERT OPINION Optimal phosphate control is still an unmet need in CKD. Nonetheless, we now have an extending range of phosphate binders available. Aluminium has potentially serious toxic risks. Calcium-based binders are still very useful but can lead to hypercalcemia and/or positive calcium balance and cardiovascular calcification. No long-term data are available for the new calcium acetate/magnesium combination product. Lanthanum is an effective phosphate binder, but there is insufficient evidence about possible long-term effects of tissue deposition. The resin-based binders, colestilan and sevelamer, appear to have profiles that would lead to less vascular calcification, and the main adverse events seen with these agents are gastrointestinal effects.
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Affiliation(s)
- Francesco Locatelli
- Alessandro Manzoni Hospital, Department of Nephrology Dialysis , Via dell'Eremo 9, 23900 Lecco , Italy +39 0341 489850 ; +39 0341 489860 ;
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Lloret M, Ruiz-García C, DaSilva I, Furlano M, Barreiro Y, Ballarín J, Bover J. Lanthanum carbonate for the control of hyperphosphatemia in chronic renal failure patients: a new oral powder formulation - safety, efficacy, and patient adherence. Patient Prefer Adherence 2013; 7:1147-56. [PMID: 24235818 PMCID: PMC3826937 DOI: 10.2147/ppa.s31694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Chronic kidney disease (CKD) is associated with very high mortality rates, mainly of cardiovascular origin. The retention of phosphate (P) and increased fibroblast growth factor-23 levels are common, even at early stages of CKD, due to disturbances in normal P homeostasis. Later, hyperphosphatemia appears, which has also been strongly associated with high mortality rates linked to P-mediated cardiovascular and procalcifying effects. Treatment guidelines for these patients continue to be poorly implemented, at least partially due to the lack of adherence to a P-restricted diet and P-binder therapy. Calcium-free P binders, such as lanthanum carbonate, have been associated with a decreased progression of vascular calcification, rendering them an important therapeutic alternative for these high cardiovascular risk CKD patients. Lanthanum carbonate has typically been available as chewable tablets, and the new presentation as an oral powder may provide a useful alternative in the therapeutic armamentarium. This powder is a tasteless, odorless, and colorless semisolid compound miscible with food. In a recent study in healthy individuals, the safety and efficacy of this novel form were evaluated, and it was concluded that it is well tolerated and pharmacodynamically equivalent to the chewable form. In the long run, individualization of preferences and treatments seems an achievable goal prior to final demonstration of improvements in hard outcomes in wide clinical trials in CKD patients.
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Affiliation(s)
- MªJesús Lloret
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - César Ruiz-García
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Iara DaSilva
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Mónica Furlano
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Yaima Barreiro
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - José Ballarín
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Jordi Bover
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
- Correspondence: Jordi Bover, Nephrology Department, Fundació Puigvert, C Cartagena 340-350, 08025 Barcelona, Spain, Tel +34 93 416 97 00, Fax +34 93 416 97 30, Email
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