Why Does It Matter When I Take My Phosphate Binders?

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Why Does It Matter When I Take My Phosphate Binders?

Life Options Rehabilitation Program Kidney 414 D’Onofrio Drive, Ste. 200 Madison, WI 53719 & www.lifeoptions.org Q 4-12A months Q: Why does it matter when I take my phosphate binders? Phosphate binders work in your gut capsules to take, depending on how much like magnets to pull phosphorus out you eat at a meal or snack. In general, the A: of the food you eat and then pass it more food you eat at a meal, the more binders out through your stool. Take them you will need. In time, you will learn to adjust when the phosphorus is present— your phosphate binder dose for the meal you while you eat or as soon as you fin- are eating. ish your meal or snack. If you wait too long, the food you eat will move out How I can take my binders correctly: of your gut and your binders won’t be able to bind the phosphorus from J Ask my dietitian how I can decide how many your food. binders to take with meals and snacks. Phosphate binders can also bind other drugs J Tell my care team about any over-the- and make them less effective. Follow your counter drugs I take, including antacids doctor’s advice about whether certain other and herbal products. Some antacids medicines can be taken at the same time as are good phosphate binders; others the phosphate binder or whether they must have ingredients that could harm me. be taken separately. J Visit module 9 of Kidney School™: Below is a list of FDA-approved phosphate Nutrition and Fluids at binders and how to take them: www.kidneyschool.org to learn about binders. How many binders to take. Your doctor or dietitian can tell you how many pills or Phosphate Binder How to Take Calcium acetate (PhosLo®) Swallow capsule whole during your meal Calcium carbonate (Tums®, Os-Cal®, Caltrate®, etc.) Chew them up and take them during your meal Sevelamer hydrochloride (Renagel®) Swallow capsule whole during your meal Lanthanum carbonate (Fosrenol®) Take one or more tablets with each meal Why does it matter when I take my phosphate binders?.

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How to Take Your Phosphate Binders
How to take your phosphate binders Information for renal patients Oxford Kidney Unit Page 2 What are phosphate binders? To reduce the amount of phosphate you absorb from your food you may have been prescribed a medicine called a phosphate binder. Phosphate binders work by binding (attaching) to some of the phosphate in food. This will reduce the amount of phosphate being absorbed into your blood stream. A list of phosphate binders and how to take them is shown below. Phosphate binder How to take it Calcichew (calcium carbonate) Chew thoroughly 10-15 minutes before or immediately before food Renacet (calcium acetate) Phosex (calcium acetate) Osvaren (calcium acetate and magnesium carbonate) Swallow whole after the first Renagel 2-3 mouthfuls of food (sevelemer hydrochloride) Renvela tablets (sevelemer carbonate) Alucaps (aluminium hydroxide) Renvela powder Dissolve in 60ml of water and (sevelemer carbonate) take after the first 2-3 mouthfuls of food Fosrenol tablets Chew thoroughly towards the (lanthanum carbonate) end/immediately after each meal Fosrenol powder Mix with a small amount of (lanthanum carbonate) food and eat immediately Velphoro Chew thoroughly after the first (sucroferric oxyhydroxide) 2-3 mouthfuls The phosphate binder you have been prescribed is: ……………………………………………………………………………………………………………………………………………………….. Page 3 How many phosphate binders should I take? You should follow the dose that has been prescribed for you. Your renal dietitian can advise how best to match your phosphate binders to your meal pattern, as well as which snacks require a phosphate binder. What happens if I forget to take my phosphate binder? For best results, phosphate binders should be taken as instructed.
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New Brunswick Drug Plans Formulary
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In-Class Targeted Therapies That Advance Patient Care
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Phosphate Binders
Pharmacy Info Sheet Phosphate Binders calcium acetate, calcium carbonate (Tums, Calsan, Apocal, Ocal), calcium liquid, aluminum hydroxide (Basaljel, Amphojel), sevelamer (Renagel), lanthanum (Fosrenol) What it does: Phosphate binders are used to treat high Special considerations for lanthamum and blood phosphorus levels. sevelamer: Calcium acetate, calcium carbonate, calcium Lanthanum should be taken during or liquid, aluminum hydroxide, lanthanum and immediately after a meal. Taking a dose on an sevelamer bind dietary phosphate. When the empty stomach can cause nausea and kidneys fail, phosphorus builds up in the body vomiting. Chew the tablet completely before because the kidneys can no longer remove swallowing. DO NOT swallow tablets whole. much phosphorus. Phosphate binders are used to lower the amount of phosphorus Sevelamer should be taken just before eating. absorbed from food to limit development of Swallow the tablet whole – Renagel should not bone and blood vessel disease. be cut or chewed. The contents of sevelamer tablets expand in water and could cause Aluminum hydroxide and calcium carbonate choking if cut chewed or crushed. may also be prescribed as antacids. Calcium preparations may also be prescribed as Phosphate binders may interfere with the calcium supplements. Use them only as absorption of certain drugs such as iron prescribed. When these medications are supplements, antibiotics, digoxin, ranitidine, prescribed as calcium supplements or antiseizure, and antiarrhythmic medications. antacids, take between meals. If you are prescribed any of these drugs, take them at least 1 hour before or 3 hours after your How it works: phosphate binder. Kidney disease can cause phosphate to accumulate which results in bone and blood What to do if you miss a dose: vessel disease.
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Dorset Medicines Advisory Group
Dorset Medicines Advisory Group SHARED CARE GUIDELINE FOR THE USE OF PHOSPHATE BINDERS IN THE MANAGEMENT OF HYPERPHOSPHATAEMIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE. INDICATION This document provides guidance for the prescribing of phosphate binders for the management of hyperphosphatemia in patients receiving haemodialysis or peritoneal dialysis and patients with chronic kidney disease stage 4 or 5 who are not receiving dialysis. This shared care guideline covers adult patients under the care of the Dorset Renal Unit. Patients with chronic renal failure have reduced ability to excrete phosphate. Phosphate accumulation enhances parathyroid activity and leads to the calcification of arteries, significantly contributing to the excess cardiovascular morbidity in these patients, especially in younger age groups. Adequate control of serum phosphate levels is thought to be beneficial for the prevention of vascular and cardiac calcification in patients with renal failure and control of parathyroid hormone. A number of oral phosphate binders are available which may be used in the context of a multiple therapeutic approach. These include calcium acetate, calcium carbonate, calcium acetate/magnesium carbonate, lanthanum, sevelamer and sucroferric oxyhydroxide. These products may be used in combination with 1-hydroxycholecalciferol (alfacalcidol) or one of its analogues and/or cinacalcet to control the development of secondary hyperparathyroidism and renal bone disease. A calcium-based phosphate binder is generally used as the initial phosphate binder therapy for the treatment for hyperphosphatemia. Calcium acetate is preferred over calcium carbonate due to its lower elemental calcium content for the equivalent phosphate binding capacity, however patient preference in formulation should be taken into consideration. A non-calcium-based phosphate binder should be used in patients who cannot tolerate a calcium-based phosphate binder, whose serum calcium exceeds 2.5mmol/L or whose parathyroid levels are less than 15pmol/L.
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Phosphate, Microbiota and CKD
nutrients Review Phosphate, Microbiota and CKD Chiara Favero 1, Sol Carriazo 1,2, Leticia Cuarental 1,2, Raul Fernandez-Prado 1,2, Elena Gomá-Garcés 1, Maria Vanessa Perez-Gomez 1,2, Alberto Ortiz 1,2,*,† , Beatriz Fernandez-Fernandez 1,2,*,† and Maria Dolores Sanchez-Niño 1,2,3,*,† 1 Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Av Reyes Católicos 2, 28040 Madrid, Spain; [email protected] (C.F.); [email protected] (S.C.); [email protected] (L.C.); [email protected] (R.F.-P.); [email protected] (E.G.-G.); [email protected] (M.V.P.-G.) 2 Red de Investigacion Renal (REDINREN), Av Reyes Católicos 2, 28040 Madrid, Spain 3 School of Medicine, Department of Pharmacology and Therapeutics, Universidad Autonoma de Madrid, 28049 Madrid, Spain * Correspondence: [email protected] (A.O.); [email protected] (B.F.-F.); [email protected] (M.D.S.-N.) † These authors contributed equally to this work. Abstract: Phosphate is a key uremic toxin associated with adverse outcomes. As chronic kidney dis- ease (CKD) progresses, the kidney capacity to excrete excess dietary phosphate decreases, triggering compensatory endocrine responses that drive CKD-mineral and bone disorder (CKD-MBD). Eventu- ally, hyperphosphatemia develops, and low phosphate diet and phosphate binders are prescribed. Recent data have identiﬁed a potential role of the gut microbiota in mineral bone disorders. Thus, parathyroid hormone (PTH) only caused bone loss in mice whose microbiota was enriched in the Th17 cell-inducing taxa segmented ﬁlamentous bacteria. Furthermore, the microbiota was required Citation: Favero, C.; Carriazo, S.; for PTH to stimulate bone formation and increase bone mass, and this was dependent on bacterial Cuarental, L.; Fernandez-Prado, R.; Gomá-Garcés, E.; Perez-Gomez, M.V.; production of the short-chain fatty acid butyrate.
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(October), 2005
VOL 46, NO 4, SUPPL 1, OCTOBER 2005 CONTENTS American Journal of AJKD Kidney Diseases K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Children With Chronic Kidney Disease Tables............................................................................................................................... S1 Figures ............................................................................................................................. S1 Acronyms and Abbreviations........................................................................................ S2 Algorithms ....................................................................................................................... S3 Work Group Members..................................................................................................... S4 K/DOQI Advisory Board Members................................................................................. S5 Foreword.......................................................................................................................... S6 Introduction ..................................................................................................................... S8 Guideline 1. Evaluation of Calcium and Phosphorus Metabolism ............................ S12 Guideline 2. Assessment of Bone Disease Associated with CKD................................ S18 Guideline 3. Surgical Management of Osteodystrophy ............................................. S23 Guideline 4. Target Serum Phosphorus Levels.........................................................
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Effectiveness of Self-Adjusted Phosphate Binder Dose According to Dietary Phosphate Content Method in Improving Hyperphosphatemia Among Hemodialysis Patients
ORIGINAL ARTICLE East J Med 25(2): 202-210, 2020 DOI: 10.5505/ejm.2020.98598 Effectiveness of Self-adjusted Phosphate Binder Dose According to Dietary Phosphate Content Method In Improving Hyperphosphatemia Among Hemodialysis Patients Su Mee Khor1, Chee Ping Chong2* 1Department of Dietary & Food Service, Penang General Hospital, Jalan Residensi, 10990 George Town, Penang, Malaysia 2Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800 Minden, Penang, Malaysia ABSTRACT Serum phosphate level control is a major goal in the management of hyperphosphatemia among end stage kidney disease patients. This study aimed to evaluate the effectiveness of self-adjusted phosphate binder dose according to dietary phosphate content method (SPB method) in optimizing the phosphate level among hemodialysis patients. This was a randomized controlled study conducted from September 2015 to October 2016 which involved eight hemodialysis centers in Penang, Malaysia. Ninety-eight hemodialysis patients who had serum phosphate level more than 1.8 mmol/L were recruited and randomly assigned to intervention and standard group. All patients underwent a standard low phosphate counseling. The 49 patients in intervention group underwent an additional counseling on how to adjust the calcium carbonate tablet dose based on their food intake with the help of a booklet. Meanwhile, the calcium carbonate dose was fixed to the meals among the patients in standard group. The change in serum phosphate levels in both groups at baseline, month-3, month-6 and month-9 were recorded. The phosphate level at baseline for intervention (2.15±0.22 mmol/L) and standard (2.22±0.27 mmol/L) group were not differed significantly (p = 0.19).
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The Effects of Colestilan Versus Placebo and Sevelamer in Patients with CKD 5D and Hyperphosphataemia: a 1-Year Prospective Randomized Study
Nephrol Dial Transplant (2014) 29: 1061–1073 doi: 10.1093/ndt/gft476 Advance Access publication 2 December 2013 The effects of colestilan versus placebo and sevelamer in patients with CKD 5D and hyperphosphataemia: a 1-year prospective randomized study Francesco Locatelli1, Goce Spasovski2, Nada Dimkovic3, Christoph Wanner4, Frank Dellanna5 and Giuseppe Pontoriero1 1Department of Nephrology Dialysis and Renal Transplantation, A Manzoni Hospital, Lecco, Italy, 2Department of Nephrology, Clinical Centre Skopje, Skopje, Macedonia, 3Medical Faculty University of Belgrade, Zvezdara University Medical Center, Belgrade, Serbia, 4Division of Nephrology, University Department of Internal Medicine I, University Clinic Würzburg, Germany and 5Gemeinschaftspraxis Karlstraße, Düsseldorf, Germany Correspondence and offprint requests to: Francesco Locatelli; E-mail: [email protected] ORIGINAL ARTICLE < 0.001), and responder rates after 1 year, using a target ABSTRACT of <1.83 mmol/L (70 mg/dL) or <2.59 mmol/L (100 mg/dL) were similar in both groups (50.7 and 85.3% for colestilan and Background. This study compared the effects of short-term 54.0 and 80.6% for sevelamer). Colestilan was generally well titrated colestilan (a novel non-absorbable, non-calcium, tolerated. phosphate binder) with placebo, and evaluated the safety and ﬁ Conclusions. Colestilan is effective and safe for the treatment ef cacy of colestilan over 1 year compared with sevelamer, in of hyperphosphataemia in patients with CKD 5D, and affords patients with chronic kidney disease (CKD) 5D. similar long-term phosphorus and cholesterol reductions/re- Methods. This prospective multicentre study comprised a sponder rates to sevelamer. 4-week phosphate binder washout period, a 16-week short- term, ﬂexible-dose, treatment period (including a 4-week Keywords: chronic kidney disease, colestilan, hyperphospha- placebo-controlled withdrawal period) and a 40-week exten- taemia, placebo, sevelamer sion treatment phase.
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Calcium and Phosphate Balance in CKD
Calcium and phosphate balance in CKD Sharon M. Moe, MD Indiana University School of Medicine Roudebush Veterans Affairs Medical Center Indiana University Health Partners Indianapolis, IN, USA Disclosures • Dr. Moe has current grant support from the NIH, the Veterans Administration, Novartis • The balance study was funded by Genzyme/ Sanofi to Dr. Munro Peacock; Dr. Moe was a co-investigator. • Dr. Moe has served as a scientific advisor/ consultant/received honoraria for Amgen and Sanofi. Current KDIGO Guidelines • 4.1.4. In patients with CKD stages 3–5 (2D) and 5D (2B), we suggest using phosphate-binding agents in the treatment of hyperphosphatemia. It is reasonable that the choice of phosphate binder takes into account CKD stage, presence of other components of CKD–MBD, concomitant therapies, and side-effect profile (not graded). • 4.1.5. In patients with CKD stages 3–5D and hyperphosphatemia, we recommend restricting the dose of calcium-based phosphate binders and/or the dose of calcitriol or vitamin D analog in the presence of persistent or recurrent hypercalcemia (1B). • In patients with CKD stages 3–5D and hyperphosphatemia, we suggest restricting the dose of calcium-based phosphate binders in the presence of arterial calcification (2C) and/or adynamic bone disease (2C) and/or if serum PTH levels are persistently low (2C). K/DOQI Guidelines In CKD Patients (Stages 3 and 4): • 5.2 Calcium-based phosphate binders are effective in lowering serum phosphorus levels (EVIDENCE) and may be used as the initial binder therapy. (OPINION) In CKD Patients With Kidney Failure (Stage 5): • 5.3 Both calcium-based phosphate binders and other noncalcium-, nonaluminum-, nonmagnesium-containing phosphate-binding agents (such as sevelamer HCl) are effective in lowering serum phosphorus levels (EVIDENCE) and either may be used as the primary therapy.
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