HYPERPHOSPHATEMIA IN END STAGE RENAL DISEASE: PREVALENCE AND PATIENTS CHARACTERISTICS OF MULTIETHNIC POPULATION OF UNITED ARAB EMIRATES


Syed Arman Rabbani, Sathvik B. S., Padma Gm Rao, Martin Thomas Kurian, Basset El Essawy

Abstract


Objective: Hyperphosphatemia is significantly associated with increased mortality among end stage renal disease (ESRD) patients on hemodialysis. There is paucity of data on hyperphosphatemia in ESRD patients of the multiethnic population of United Arab Emirates (UAE). The study aimed to investigate the prevalence and characteristics of hyperphosphatemia in ESRD patients of the multiethnic population of UAE undergoing maintenance hemodialysis.

Methods: Adults ESRD patients undergoing maintenance hemodialysis for more than six months at the study site were included. Demographic, clinical and biological data of the patients were collected. Patient characteristics were compared as per the serum phosphate level, between patients with or without hyperphosphatemia. Univariate and multivariate logistic regression analyses were carried out to identify the predictors of hyperphosphatemia.

Results: Hyperphosphatemia was present in 73.8% of the study population, while 31.3% presented with high calcium-phosphate product. Univariate logistic analysis revealed that hyperphosphatemia was inversely correlated with age, hemoglobin, serum calcium, and hypertensive nephropathy as cause of renal disease, and positively correlated with female gender, expatriate status, body mass index (BMI), higher number of comorbidities, calcium-phosphate product and parathyroid hormone (PTH). Multivariate logistic regression model revealed that only age, BMI, hemoglobin and PTH independently correlated with hyperphosphatemia.

Conclusion: We report a high prevalence of hyperphosphatemia in multiethnic study population undergoing maintenance hemodialysis at a secondary care hospital in UAE. In this study population, only age, BMI, hemoglobin and PTH were identified as independent predictors of hyperphosphatemia.


Keywords


Hyperphosphatemia, ESRD, hemodialysis, serum phosphate.

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References


Giachelli CM. The emerging role of phosphate in vascular calcification. Kidney Int 2009;75:890-7.

Nishizawa Y, Jono S, Ishimura E, Shioi A. Hyperphosphatemia and vascular calcification in end-stage renal disease. J Ren Nutr 2005;15:178-82.

Coladonato JA. Control of hyperphosphatemia among patients with ESRD. J Am Soc Nephrol 2005;16 Suppl 2:S107-14.

Shaman AM, Kowalski SR. Hyperphosphatemia management in patients with chronic kidney disease. Saudi Pharm J 2016;24:494-505.

Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004;15:2208-18.

Naves Díaz M, Passlick Deetjen J, Guinsburg A, Marelli C, Fernández Martín JL, Rodríguez-Puyol D, et al. Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from latin America. The CORES Study. Nephrol Dial Transplant 2011;26:1938-47.

Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 2008;52:519-30.

Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO, Ca x PO product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001;12:2131-8.

Dhingra R, Gona P, Benjamin EJ, Wang TJ, Aragam J, D’Agostino RBSr, et al. Relations of serum phosphorus levels to echocardiographic left ventricular mass and incidence of heart failure in the community. Eur J Heart Fail 2010;12:812-8.

McGovern AP, de Lusignan S, van Vlymen J, Liyanage H, Tomson CR, Gallagher H, et al. Serum phosphate as a risk factor for cardiovascular events in people with and without chronic kidney disease: a large community-based cohort study. PLoS One 2013;8:e74996.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl; 2009. p. S1-130.

Floege J. Phosphate binders in chronic kidney disease: a systematic review of recent data. J Nephrol 2016;29:329-40.

Lee CT, Wu IW, Chiang SS, Peng YS, Shu KH, Wu MJ, et al. Effect of oral ferric citrate on serum phosphorus in hemodialysis patients: multicenter, randomized, double-blind, placebo-controlled study. J Nephrol 2015;28:105-13.

Spasovski G. Advances in pharmacotherapy for hyperphosphatemia in renal disease. Expert Opin Pharmacother 2015;16:2589-99.

Sherman RA. Hyperphosphatemia in dialysis patients: beyond nonadherence to diet and binders. Am J Kidney Dis 2016;67:182-6.

Afifi A, El-Sayed H, El-Setouhi M, Ahmed H, Khalifa N. Hyperphosphatemia among end-stage renal disease patients in developing countries: a forgotten issue? Hemodial Int 2005; 9:409-15.

Young EW, Albert JM, Satayathum S, Goodkin DA, Pisoni RL, Akiba T, et al. Predictors and consequences of altered mineral metabolism: the dialysis outcomes and practice patterns study. Kidney Int 2005;67:1179-87.

Ramos AM, Albalate M, Vázquez S, Caramelo C, Egido J, Ortiz A. Hyperphosphatemia and hyperparathyroidism in incident chronic kidney disease patients. Kidney Int Suppl 2008;111:S88-93.

Block GA, Port FK. Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis 2000;35:1226-37.

Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998;31:607-17.

Ferreira A, Frazao JM, Monier-Faugere MC, Gil C, Galvao J, Oliveira C, et al. Sevelamer study group. Effects of sevelamer hydrochloride and calcium carbonate on renal osteodystrophy in hemodialysis patients. J Am Soc Nephrol 2008;19:405-12.

St Peter WL, Liu J, Weinhandl E, Fan Q. A comparison of sevelamer and calcium-based phosphate binders on mortality, hospitalization, and morbidity in hemodialysis: a secondary analysis of the dialysis clinical outcomes revisited (DCOR) randomized trial using claims data. Am J Kidney Dis 2008;51:445-54.

Laurain E, Thilly N, Boini S, Kessler M, Briançon S, Frimat L. Hyperphosphatemia in chronic kidney disease: patient characteristics and dialysis mortality during the first year of dialysis. J Nephrol Ther 2012;S3:009.

Bellasi A, Mandreoli M, Baldrati L, Corradini M, Di Nicolò P, Malmusi G, et al. Chronic kidney disease progression and outcome according to serum phosphorus in mild-to-moderate kidney dysfunction. Clin J Am Soc Nephrol 2011;6:883-91.

Cirillo M, Ciacci C, De Santo NG. Age, renal tubular phosphate reabsorption, and serum phosphate levels in adults. N Engl J Med 2008;359:864-6.

Onufrak SJ, Bellasi A, Cardarelli F, Vaccarino V, Muntner P, Shaw LJ, et al. Investigation of gender heterogeneity in the associations of serum phosphorus with incident coronary artery disease and all-cause mortality. Am J Epidemiol 2009;169:67-77.

Wojcicki JM. Hyperphosphatemia is associated with anemia in adults without chronic kidney disease: results from the National Health and Nutrition Examination Survey (NHANES): 2005-2010. BMC Nephrol 2013;14:178.

Uemura H, Irahara M, Yoneda N, Yasui T, Genjida K, Miyamoto KI, et al. Close correlation between estrogen treatment and renal phosphate reabsorption capacity. J Clin Endocrinol Metab 2000;85:1215-9.

Wang AY, Woo J, Sea MM, Law MC, Lui SF, Li PK. Hyperphosphatemia in Chinese peritoneal dialysis patients with and without residual kidney function: what are the implications? Am J Kidney Dis 2004;43:712-20.

Tran L, Batech M, Rhee CM, Streja E, Kalantar-Zadeh K, Jacobsen SJ, et al. Serum phosphorus and association with anemia among a large diverse population with and without chronic kidney disease. Nephrol Dial Transplant 2016;31:636-45.

Grzegorzewska AE, Młot-Michalska M. Bone mineral density, its predictors, and outcomes in peritoneal dialysis patients. Adv Peritoneal Dial 2011;27:140-5.

Kovesdy CP, Mucsi I, Czira ME, Rudas A, Ujszaszi A, Rosivall L, et al. Association of serum phosphorus level with anemia in kidney transplant recipients. Transplantation 2011;91:875-82.

Meytes D, Bogin E, Ma A, Dukes PP, Massry SG. Effect of parathyroid hormone on erythropoiesis. J Clin Invest 1981;67:1263-9.

Bogin E, Massry SG, Levi J, Djaldeti M, Bristol G, Smith J. Effect of parathyroid hormone on osmotic fragility of human erythrocytes. J Clin Invest 1982;69:1017-25.

Rao DS, Shih MS, Mohini R. Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia. N Engl J Med 1993;328:171-5.

Hruska KA, Mathew S, Lund R, Qiu P, Pratt R. Hyperphosphatemia of chronic kidney disease. Kidney Int 2008;74:148-57.

Kestenbaum B, Belozeroff V. Mineral metabolism disturbances in patients with chronic kidney disease. Eur J Clin Invest 2007;37:607-22.




About this article

Title

HYPERPHOSPHATEMIA IN END STAGE RENAL DISEASE: PREVALENCE AND PATIENTS CHARACTERISTICS OF MULTIETHNIC POPULATION OF UNITED ARAB EMIRATES

Keywords

Hyperphosphatemia, ESRD, hemodialysis, serum phosphate.

DOI

10.22159/ijpps.2017v9i12.22425

Date

01-12-2017

Additional Links

Manuscript Submission

Journal

International Journal of Pharmacy and Pharmaceutical Sciences
Vol 9, Issue 12, 2017 Page: 283-287

Online ISSN

0975-1491

Statistics

29 Views | 7 Downloads

Authors & Affiliations

Syed Arman Rabbani
Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates

Sathvik B. S.
Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates

Padma Gm Rao
Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates

Martin Thomas Kurian
Consultant Nephrologist, Ibrahim bin Hamad Obaidallah Hospital, Ras al Khaimah, United Arab Emirates

Basset El Essawy
Adjunct Professor, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates


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