Hyperphosphataemia as an important complication of chronic renal insufficiency and chronic renal failure, part 2 – treatment
Authors:
J. Smržová
Authors place of work:
Dialyzační a nefrologické oddělení Interní gastroenterologické kliniky Lékařské fakulty MU a FN Brno, pracoviště Bohunice
přednosta prof. MUDr. Petr Dítě, DrSc.
Published in the journal:
Vnitř Lék 2005; 51(3): 337-344
Category:
Reviews
Summary
Hyperphosphataemia is a commonly found complication of severe renal insufficiency. However, minor disturbances of calcium-phosphate metabolism are encountered in mild to moderate renal insufficiency and, as a result, can be found in up to 5% of population. They lead not only to renal bone disease but also to extraosseal calcifications (including the vascular ones) and increase in mortality rate. Their impact on the patients’ quality of life is very significant, too. The treatment of hyperphosphataemia is closely associated with the therapy of renal bone disease. It consists in dietary restrictions, the use of a constantly widening range of phosphate binders, active metabolites of vitamin D and their analogues, therapy of metabolic acidosis, customising dialysis regimen in dialysed patients and surgical treatment atadvanced stages of secondary hyperparathyreoidism. This represents a long-term treatment that should be conducted by nephrologists in patients with moderate to severe renal insufficiency and by internists in patients with mild renal insufficiency. This paper gives details pertaining to all the kinds of hyperphosphataemia treatment including the concrete medication available. Finally, therapeutic recommendations for all the types of calcium-phosphate metabolism disturbances are given. These recommendations are based on the up-to-date treatment standards as well as the author’s own clinical experience.
Key words:
hyperphosphataemia – renal bone disease – hyperparathyroidism – renal insufficiency – haemodialysis – phosphate binders
Zdroje
1. Andress DL, Norris KC, Coburn JW et al. Intravenous calcitriol in the treatment of refractory osteitis fibrosa of chronic renal failure. N Engl J Med 1989; 321: 274–279.
2. Block GA, Hulbert-Shearon TE, Levin NW et al. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic haemodialysis patients. A national study. Am J Kidney Dis 1998; 31: 607–617.
3. Block GS, Martin KJ, de Francisco AL et al. Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. NEJM 2004; 350: 1565–1567.
4. Braun J, Oldendorf M, Moshage W et al. Electron beam computed tomograpy in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis 1996; 27: 394–401.
5. Broulík P. Poruchy kalciofosfátového metabolismu. Praha: Grada 2003.
6. Coburn JW. Use of oral and parenteral calcitriol in the treatment of renal osteodystrophy. Kidney Int 1990; 38(Suppl): S54.
7. D’Haese PC, Spasovski GB, Sikole A et al. A multicenter study on the effects of lanthanum carbonate (Fosrenol) and calcium carbonate on renal bone disease in dialysis patients. Kidney Int 2003; 85 (Suppl): S73–S78.
8. Date T, ShigematsuT, Kawashita Y et al. Colestimide can be used as a phosphate binder to treat uraemia in end-stage renal disease patients. Nephrol Dial Transplant 2003; 18(Suppl 3): iii90–93.
9. Delmez JA, Tindira CA, Windus DW et al. Calcium acetate as a phosphorus binder in hemodialysis patients. J Am Soc Nephrol 1992; 3: 96–102.
10. Don BR, Chin AI. A strategy for the treatment of calcific uremic arteriolopathy (calciphylaxis) employing a combination of therapies. Clin Nephrol 2003; 6: 463–470.
11. Dzúrik R, Spustová V. Nefrogénna metabolická acidóza. Vnitř Lék 2003; 49(5): 370–373.
12. Fine A, Zacharias J. Calciphylaxis is usually non-ulcerating: Risk factors, outcome and therapy. Kidney Int 2002; 61: 2210.
13. Finch JL, Brown AJ, Kubodera N et al. Differential effects of 1.25-(OH)2D3 and 22-oxacalcitriol on phosphate and calcium metabolism. Kidney Int 1993; 43: 561.
14. Finn WF, Joy MS, Webster I et al. A long term (2-year) assessment of the safety and efficacy of lanthanum carbonate, a non-calcium, non-aluminium phosphate binder, for the treatment of hyperphosphataemia. Poster at the 40th ERA-EDTA World Congress of Nephrology, Berlin, Germany, 8–12 June, 2003.
15. Chauveau P et al. Phosphate removal rate: a comparative study of five high-flux dialysers. Nephrol Dial Transplant 1992; 2(Suppl): 114–115.
16. Chertow GM, Dillon M, Burke SK et al A randomized trial of sevelamer hydrochloride (RenaGel) with and without supplemental calcium. Strategies for the control of hyperphosphatemia and hyperparathyroidism in hemodialysis patients. Clin Nephrol 1999; 51: 18–26.
17. Lefebvre A, de Vernejoul MC, Gueris J et al. Optimal correction of acidosis changes progression of dialysis osteodystrophy. Kidney Int 1989; 36: 1112–1118.
18. Locatelli F, Cannata-Andia JB, Drueke T et al. Management of disturbancies of calcium and phosphate metabolism in chronic renal insufficiency, with emphasis on the control of hyperphosphataemia. Nephrol Dial Transplant 2002; 17: 723–731.
19. Locatelli F, Del Vecchio I, Pozzoni P. The importance of early detection of chronic kidney disease. Nephrol Dial Transplant 2002; 17(Suppl 1): 2–7.
20. Loghman-Adham M. Safety of new phosphate binders for chronic renal failure. Drug Saf 2003; 26: 1093–1115.
21. Martin KJ, Gonzalez E, Gellens M et al. 19-Nor-1-alpha-25-dihydroxyvitamin D2 (Paricalcitol) safely and effectively reduces the levels of intact parathyroid hormone in patients on hemodialysis. J Am Soc Nephrol 1998; 9: 1427–1432.
22. Molitoris BA, Froment DH, Mackenzie TA et al. Citrate: A major factor in the toxicity of orally administered aluminum compounds. Kidney Int 1989; 36: 949–953.
23. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42 (Suppl 3): S1–201.
24. Raggi P, Boulay A, Chasan-Taber S et al. Cardiac calcification in adult hemodialysis patients. A link between end/stage renal disease and cardiovascular disease? J Am Coll Cardiol 2002; 39(4): 695–701.
25. Salusky IB, Foley J, Nelson P et al. Aluminum accumulation during treatment with aluminum hydroxide and dialysis in children and young adults with chronic renal disease. N Engl J Med 1991; 324: 527–531.
26. Sellarez LV, Ramirez TA. Management of hyperphosphataemia in dialysis patients: role of phosphate binders in the elderly. Drugs Aging 2004; 21: 153–165.
27. Schiller LR, Santa Ana CA, Sheikh MS et al. Effect of the time of administration of calcium acetate on phosphorus binding. N Engl J Med 1989; 320: 1110–1113.
28. Schück O, Tesař V, Teplan V et al. Konzervativní léčení chronického selhání ledvin. In: Schück O. Klinická nefrologie. Praha: Medprint 1995:179–198.
29. Slatopolsky E, Burke SK, Dillon MA. RenaGel, a nonabsorbed calcium– and aluminum–free phosphate binder, lowers serum phosphorus and parathyroid hormone. The RenaGel study group. Kidney Int 1999; 55: 299–307.
30. Slatopolsky E, Finch J, Denda M et al. Phosphorus restriction prevents parathyroid gland growth. High phosphorus directly stimulates PTH secretion in vitro. J Clin Invest 1996; 97: 2534–2540.
31. Slatopolsky E, Weerts C, Lopez-Hilker S et al. Calcium carbonate as a phosphate binder in patients with chronic renal failure undergoing dialysis. N Engl J Med 1986; 315: 157–161.
32. Slatopolsky E, Berkoben M, Kelber J et al. Effects of calcitriol and non–calcemic vitamin D analogs on secondary hyperparathyroidism. Kidney Int 1992; 38(Suppl): S43–49.
33. Slatopolsky E, Weerts C, Thielan J et al. Marked suppression of secondary hyperparathyroidism by intravenous administration of 1.25-dihydroxycholecalciferol in uremic patients. J Clin Invest 1984; 74: 2136–2143.
34. Slatopolsky E. The interaction of parathyroid hormone and aluminum on renal osteodystrophy. Kidney Int 1987; 31: 842–854.
35. Sotorník I et al. Kostní choroba při nezvratném selhání ledvin. Praha: Scientia Medica 1994.
36. Sotorník I, Bubeníček P, Adamec M et al. Poruchy funkce příštítných tělísek u nemocných v pravidelném dialyzačním léčení a po transplantaci ledviny. Čas Lék Čes 2003; 4: 229–234.
37. Sotorník I, Bubeníček P. Kostní choroba u nemocných s chronickým selháním ledvin II. část: Diagnostika a léčení kostní choroby. Osteol Bul 2000; 4: 114–122.
38. Sotorník I, Petrásek R, Schück O et al. Nárazové dávky kalcitriolu při léčení sekundární hyperparatyreózy u hemodialyzovaných nemocných. Vnitř Lék 1997; 43(9): 584–591.
39. Stracke S, Jehle PM, Sturm D et al. Clinical course after total parathyroidectomy without autotransplantation in patients with end-stage renal failure. Am J Kidney Dis 1999; 33: 304–311.
40. Sulková S et al. Renální osteopatie. In: Sulková S. Hemodialýza. Praha: Maxdorf 2000.
41. Sulková S, Fořtová M, Válek M et al. Renální kostní choroba. Vnitř Lék 2003; 49(5): 403–408.
42. Sulková S. Epidemiologie funkčního postižení ledvin. Vnitř Lék 2003; 49(5): 358–361.
43. Tan AU, Levine BS, Mazess RB et al. Effective suppression of parathyroid hormone by 1-alpha-hydroxy-vitamin D2 in hemodialysis patients with moderate to severe secondary hyperparathyroidism. Kidney Int 1997; 51: 317–323.
Štítky
Diabetology Endocrinology Internal medicineČlánok vyšiel v časopise
Internal Medicine
2005 Číslo 3
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