Author: Leo
Key words: chronic kidney disease | binding agent | patients | chronic renal
insufficiency |
 |
| From google images |
The amount of phosphorus in each protein-rich food is different, that is, the phosphorus / protein ratio is different, such as egg white phosphorus / protein ratio 1.4, egg yolk pear / protein ratio 24.7, milkshake phosphorus / protein ratio Up to 41.3. At present, calcium-containing binders are commonly used in China, but the study found that the use of high-dose calcium-containing phosphate binders was associated with an increased risk of hypercalcemia, metastatic calcification and coronary artery calcification.
Hyperthyroidism is common in patients with chronic renal insufficiency and S syndrome, local dish on the blood Han, the whole parathyroid hormone (iPTH), l, 25 (OH) 2D3, fibroblast growth factor 23 (FGF23) Have important regulatory effects and therefore play a key role in chronic kidney disease mineral fecal and bone abnormalities (CKD-MIiD).
In the dialysis population, CKD3 ~ 5 non-dialysis groups and normal renal function in the epidemiological survey showed that high levels of serum phosphorus and cardiovascular disease incidence and mortality increased. Therefore, the control of hyperphosphatemia has become a huge challenge facing kidney physicians.
Data from the Chinese DOPPS showed that the compliance rate of blood phosphorus in hemodialysis patients was <50%, significantly lower than that of developed countries (K / DOQI guidelines 3.5 to 5.5 mg / dl). What is the reason why blood phosphorus is difficult to control? What should we do?
Elevated levels of phosphorus are nothing more than an increase in the amount of excretion caused by the reduction. So the comprehensive phosphorus reduction measures is very necessary.
Reduce phosphorus intake and absorption
Phosphorus is mainly found in protein-rich foods, limiting phosphorus-containing foods will inevitably lead to inadequate intake of protein, thus affecting the nutritional status of patients, and bring poor prognosis. How do we reduce the intake of phosphorus?
First, the amount of phosphorus in each protein-rich food is different, that is, the phosphorus / protein ratio is different, such as egg white phosphorus / protein ratio 1.4, egg yolk pear / protein ratio 24.7, milkshake phosphorus / Protein ratio of up to 41.3.
In addition, phosphorus in food is present in three forms, including inorganic o-, organophosphorus and phytate. They are different in the intestinal absorption rate, natural foods are mostly organic phosphorus, can not be completely hydrolyzed, so the phosphorus absorption rate of 40% to 60%. Food additives in the phosphorus is inorganic phosphorus, easy to be hydrolyzed, phosphorus absorption rate of up to 90% to 100%.
Plant protein and phytate in the intestinal absorption rate of phosphorus than animal protein. In addition, some drugs also have the role of promoting intestinal phosphorus absorption, such as active vitamin D preparations.
In short, we should try to eat on the basis of nutrition, try to eat those low pic / protein ratio of food, eating natural plant protein and animal protein, to avoid eating a large number of additives containing food, such as processed meat, ham, sausage, fish Canned food, baked food, cola and other soft drinks.
Promote the excretion of phosphorus
The use of phosphorus binding agent 70% of the phosphorus through the kidney excretion, renal insufficiency, especially end-stage renal disease patients, often need to use phosphorus binding agent, increase phosphorus from the intestinal excretion. From the last century 60 ~ 70 years of aluminum-containing phosphorus binder to the 80's calcium-containing phosphorus binder to 90 years after the introduction of phosphorus and aluminum-free phosphorus binder, has undergone tremendous development, in order to effectively control the high phosphorus Hyperlipidemia, to avoid adverse reactions to create the conditions.
At present, calcium-containing binders are commonly used in China, but the study found that the use of high-dose calcium-containing phosphate binders was associated with an increased risk of hypercalcemia, metastatic calcification and coronary artery calcification.
Therefore, the KDIGO guidelines suggest that patients with hypercalcemia, arterial calcification and PTH <150 pg / ml and / or power deficient bone disease should limit the use of calcium-based phosphorus binders.
If the application of aluminum-containing phosphorus binders can not be applied due to the conditions, it is possible to use the formulation containing aluminum (4 weeks) for a short period of time and then use other types of preparations. When applying aluminum-containing preparations, consider increasing the dialysis frequency. On the other hand, in the use of calcium-containing phosphorus binder, should pay attention to reduce calcium intake, daily total ion intake of calcium (including drugs and diet) does not exceed 2000mg. Minimize the dosage of calcium-absorbing drugs (such as active vitamin D) and dialysis dialysis using low calcium concentrations to maintain blood calcium levels within the target range.
At present, China has been listed in the calcium and aluminum-free phosphorus binder are stevioside and lanthanum carbonate. A large number of randomized controlled studies have confirmed that they have reduced the effect of phosphorus and have little effect on serum calcium. In addition, for the study of the Weilulam found that it also reduces blood lipids (total cholesterol and low density lipoprotein) role.
There is a meta-analysis of the use of calcium-containing and calcium-free phosphate binders, and the results show that all-cause mortality using calcium-free phosphate binders is significantly lower than that of calcium-containing binders and arterial calcification Benefit significantly. Therefore, calcium and aluminum without a new type of phosphorus binders have important clinical application prospects, worthy of our attention.
Increase dialysis clear theory, whether hemodialysis or peritoneal dialysis, can be a good removal of small molecules. Usually a single hemodialysis after the level of blood phosphorus will be significantly decreased. Why is it difficult to control hyperphosphatemia?
This is related to the distribution of phosphorus in the body, the extracellular fluid phosphorus is only 1%, and part of the protein binding, and intracellular and bone phosphorus exchange is slow, so the conventional hemodialysis can only remove about 800mg of phosphorus , While the peritoneal dialysis day can only clear pies 300 ~ 315mg. This is why the study shows that the use of different dialyzers, increased dialysis blood flow and so failed to improve hyperphosphatemia, and increase the frequency of hemodialysis or prolong the dialysis time can increase the removal of phosphorus.
In short, we should pay attention to CKD patients with hyperphosphatemia, the use of scientific and rational strategy for integrated management.
Email:kdtinchina@yahoo.com
whatsapp:008615931093124
