Control of serum phosphorus in uremia

Article Abstract:

Chronic renal insufficiency is characterized by decreased kidney function. As a result of this disease almost all patients retain the nonmetallic element phosphorus, an excess of which can lead to hyperparathyroidism (excess parathyroid production) and nonbone calcifications. This excess phosphorus can be reduced by the use of oral calcium or aluminum salts which bind to the phosphorus and are eliminated in the urine. Other methods include the restriction of dietary phosphates and kidney dialysis. The restriction of phosphorus in the diet reduces the excess in some patients but not all. Dialysis, a treatment that uses a thin membrane to remove fluid and chemicals from the blood, is poor at removing phosphorus. New research found that calcium binders are most effective when given with meals rather than two hours after. The need for large doses to be taken at meals is thought to affect patient compliance. Dietary phosphorus intake should remain between 800-1000 mg per day. It is suggested that calcium carbonate be used until calcium acetate has proven efficacy. The search for phosphate binders without potentially toxic side effects should continue.

Care and treatment, Prevention, Phosphates, Calcium carbonate, Hyperparathyroidism, editorial, Calcium acetate

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Intravenous calcitriol in the treatment of refractory osteitis fibrosa of chronic renal failure

Article Abstract:

Osteitis fibrosa is a frequent complication of chronic renal failure. It is most ofter found in patients with end-stage (chronic) renal disease (ESRD) and is characterized by increased rates of both bone formation and bone resorption due to increased secretion of parathyroid hormone (PTH). Oral treatment with clacitriol (vitamin D) is often impossible in patients with osteitis fibrosa. Short-term infustions of intravenous calcitriol are capable, however, of suppressing the secretion of PTH in patients with uremia without causing hypercalcemia. The researchers evaluated the effectiveness of long-term intermittent clacitriol infusions in twelve patients whose disease was not responding to conventional therapy. The intravenous calcitriol treatment is a safe and effective means of reducing accelerated rates of bone turnover in patients with moderate and severe hyperthyroidism due to ESRD.

Analysis, Evaluation, Complications and side effects, Bone resorption, Osteoblasts, Bone regeneration, Calcitriol

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Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis

Article Abstract:

Many relatively young patients with end-stage kidney disease may also have excessive calcium deposits in their coronary arteries. This was the conclusion of a study of 39 patients on dialysis and 60 healthy volunteers. All persons in both groups were 30 years old or younger. Electron-beam CT scans of their coronary arteries showed that 14 of the 16 dialysis patients over 20 years old had excessive calcium deposits. None of the younger dialysis patients had excessive calcium deposits. Only 3 of the 60 healthy volunteers had excessive calcium deposits. A metabolic abnormality could cause the excess calcium deposits.

Physiological aspects, Arteries, Calcification, Hemodialysis patients

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