Oral phosphate binders - Alastair J Hutchison
Link to full text article. Kidney International - 75:9:906-914 - May 2009
Achievement of opinion-based guidelines appears to have become an end in itself. Dialysis patient outcomes are worse than outcomes for many types of cancer, yet prospective, outcome-based randomized controlled trials are not being undertaken for reasons that are difficult to explain.
The emerging role of phosphate in vascular calcification - Cecilia M Giachelli
Link to full text article. Kidney International - 75:9:890-897 - May 2009
Vascular calcification is a major contributor to CVD in ESRD patients. Susceptibility to vascular calcification is genetically determined and involves a growing number of inducers and inhibitors. Hyperphosphatemia promotes vascular calcification in part by promoting SMCs to undergo an osteochondrogenic phenotype change through a mechanism requiring sodium-dependent phosphate cotransporters. Upregulation of sodium-dependent phosphate cotransporters in SMCs by disease state and cytokines may facilitate vascular calcification even when serum phosphate levels are in the normal range.
Phosphate: despite advances in research, the benefits to patients remain limited - Marc E De Broe
Link to full text article. Kidney International - 75:9:880-881 - May 2009
Finally, what can the practicing physician do with all these new 'promising' concepts? Not that much as we can read in the conclusion of Hutchison's review. Indeed, three generations of phosphate binders have not been able to answer the question of the benefits of reducing serum phosphate in ESRF patients, let alone patients with CKD 4 and 5. High-quality comparative randomized controlled trials are badly needed, making the plethora of 'biochemical target' studies obsolete.
Hypokalaemia: an independent risk factor of enterobacteriaceae peritonitis in CAPD patients - Ya-Wen Chuang, Kuo-Hsiung Shu, Tung-Min Yu, Chi-Hung Cheng, and Cheng-Hsu Chen
Link to abstract. Nephrology Dialysis Transplantation - 24:5:1603-1608 - May 2009
CAPD patients with hypokalaemia are associated with a higher prevalence of peritonitis and poor nutritional status. Enterobacteriaceae were the predominant organisms causing peritonitis in the group with hypokalaemia. This unique and novel finding implies the translocation of these organisms from intestinal mucosa into the peritoneal cavity. A pathogenic mechanism linking malnutrition and hypokalaemia is also proposed.
Hemodialysis modality, percentage of body fat, and patient survival - M. Stosovic, M. Stanojevic, M. Radovic, S. Simic-Ogrizovic, V. Lezaic, R. Naumovic, D. Jovanovic, G. Ristic, L. Djukanovic, J. Marinkovic
Link to abstract. International Journal of Artificial Organs - 32:1:20-30 - January 2009
Changes in hemodialysis modality were followed by both higher body fat percentage and patient survival. The reverse epidemiology of overweight patients might be at least partially the result of the influence of nonnutritional factors, such as a change in hemodialysis modality (introducing biocompatible high-flux and low-flux membranes and bicarbonate dialysis).
Vitamin D: Physiology and pathophysiology - Maurizio Gallieni, Mario Cozzolino, Giuditta Fallabrino, Sabina Pasho, Laura Olivi, Diego Brancaccio
Link to abstract. International Journal of Artificial Organs - 32:2:87-94 - February 2009
In this review article we summarize the basic concepts regarding vitamin D metabolism, transport, and genomic activity through the vitamin D receptor, facilitating activation or suppression of target genes. We also examine non-genomic actions, biological responses to vitamin D in classic target organs (intestine, bone, kidneys, and parathyroid glands), and in organs and tissues not related to mineral homeostasis.
