Increased 1,25-dihydroxyvitamin D3 synthesis in rats fed a high-phosphorus diet

Summary Rats fed vitamin D-deficient diets containing 0.6% Ca and 0.3%, 0.6%, 1.2%, or 1.8% P exhibited progressive increments of hypocalcemia and hyperphosphatemia. In vitro assay of 25-hydroxyvitamin D₃-1-α-hydroxylase (1-α-hydroxylase) activity in isolated kidney cortical mitochondria showed that hyperphosphatemia in the presence of hypocalcemia was associated with an increase in enzyme activity. The results indicate that the stimulation of 1-α-hydroxylase associated with depressed plasma Ca in rats fed a high-P diet overrides any inhibition of the enzyme that may be caused by excess plasma phosphate.     

不同种透析膜对维持性血液透析患者血磷的清除效果

目的 观察不同种透析膜对维持性血液透析患者血磷的清除效果。方法 对我院14例高磷血症患者分别采用铜仿膜、血仿膜、三氯醋酸纤维素膜、双氯醋酸纤维素膜、高通量聚砜膜透析器透析,比较透析前后血磷水平。结果 采用血仿膜透析血磷下降幅度最大;透析后血磷水平升高,48小时接近血透前水平。结论 血仿膜有较好清除磷的效果。     

血液透析患者血磷水平与颈动脉内-中膜厚度的关系

目的 研究血液透析患者血磷水平与颈动脉内-中膜厚度（IMT）的关系,探讨尿毒症患者不同于一般人群的致动脉硬化的危险因素.方法 选择首都医科大学附属复兴医院肾内科79例维持性血液透析患者,应用高分辨二维超声测量血液透析患者颈动脉内-中膜厚度,并监测血磷水平.结果 IMT≥0.93mm（最高三分位值）组患者年龄、血磷和血浆tHcy水平高于IMT＜0.93mm组的患者（P＜0.05）.IMT与年龄、血磷、Hs-CRP和tHcy呈正相关关系,与白蛋白呈负相关关系.以IMT增厚（IMT≥0.85mm,中位数）为因变量,性别、吸烟、年龄、血磷、白蛋白、tHcy和Hs-CRP为自变量,进行多元逐步Logist回归分析,结果年龄和血磷进入了回归方程.结论 除年龄外,高血磷是血液透析患者颈动脉内-中膜增厚的独立危险因素.     

Spurious hyperphosphatemia in a patient with alteplase-locked central venous catheter

Alteplase has been shown to be effective in preventing central venous access clotting in patients on hemodialysis. Because of a high phosphorus content in its excipient, it can inadvertently contaminate blood samples, leading the physician in care of the patient to erroneously increase dialysis time or change diet in order to control the pseudo-hyperphosphatemia.     

Development and reversibility of impaired mineralization associated with lanthanum carbonate treatment in chronic renal failure rats

BACKGROUND: We have previously shown that administration of the new phosphate binder lanthanum (La) carbonate at high doses during 12 weeks induces a mineralization defect (MD) in chronic renal failure (CRF) rats most likely due to the powerful phosphate binding. In this study, we want to investigate the fate and possible biological activities of La once it is accumulated in bone. METHODS: CRF animals (5/6th nephrectomy) received La carbonate (2,000 mg/kg/day) via oral gavage for 2 or 6 weeks and were sacrificed immediately at the end of the treatment period and after a wash out period of 2 and 8 weeks. Bone histomorphometry and measurement of bone La content were performed. Control CRF animals received vehicle only. RESULTS: After 2 weeks of La treatment, 75% of the animals showed signs of MD compared to 14% in CRF controls despite similar bone La levels. Two weeks after arrest of La treatment, bone La levels remained unchanged, yet 87% showed normal bone histology. A similar evolution was noted in the animals treated for 6 weeks. Bone histology showed a reduction of number of animals with a MD from 62.5% at 6 weeks of La treatment to 20% and 28% 2 and 8 weeks after arrest of La treatment respectively. CONCLUSION: The phosphate-binder-induced MD may appear and disappear without any change in either the perimeter of active osteoblasts or in bone La levels. Bone histology in CRF animals normalized after arrest of the La administration, thereby presenting further arguments for the MD in La-treated animals to result from the high phosphate binding capacity of La rather than being the consequence of a direct effect of La on bone.     

The secondary dyslipidemia and deranged serum phosphate concentration in thyroid disorders

Hyperlipidemia is a secondary disorder associated with many metabolic disorders including hypothyroidism. The occurrence of dyslipidemia in subclinical hypothyroidism is controversial. Hyperphosphatemia may accompany the dyslipidemia in some metabolic disorders. Both hyperlipidemia and hyperphosphatemia are considered to be risk factors for the coronary heart diseases. In the present study, we investigated the occurrence of dyslipidemia and altered serum phosphate concentrations in patients with thyroid disorders. The results indicated a significantly elevated serum cholesterol and triglyceride concentrations in the hypothyroid patients. The dyslipidemia was accompanied with significantly elevated serum phosphate level. On the other hand, no significant difference was evident in the serum lipid or phosphate concentrations of subclinical hypothyroid patients compared to euthyroid subjects. A significantly reduced serum phosphate level was shown in hyperthyroid patients with unaltered serum lipid levels. Significant correlations were evident between TSH and T(4) levels as independent parameters and the serum concentrations of triglyceride, cholesterol and phosphate. The results indicate in hypothyroidism that a secondary hyperphosphatemia may aggravate myocardial and arterial abnormalities induced by the secondary hyperlipidemia, which may need correction.     

烟酸和烟酰胺治疗血液透析患者高磷血症的研究进展

【摘要】 慢性肾脏病（CKD）是全球公共健康问题之一。在中国,成年人CKD患病率高达108%。高磷血症是CKD患者常见的严重并发症之一,往往发生于终末期肾病（End stage renaldisease,ESRD）阶段。高磷血症也是CKD患者心血管事件（CVD）发生的高危因素,在血液透析(Hemodialysis,HD)患者中较为普遍,增加CKD患者死亡风险。目前,控制高磷血症通常需要联合低磷饮食、充分透析、降磷药物治疗。其中,磷酸盐结合剂在临床上运用较多。但近年来,大量研究表明烟酸和烟酰胺能有效降低血液透析患者血磷水平,本文就此研究进展作一综述。     

基于微信平台的健康教育路径对高磷血症血液透析患者饮食教育的效果探讨

目的探讨基于微信平台的健康教育路径对高磷血症血液透析患者饮食教育的效果。方法选取2017年7月至2018年7月于我院行维持性血液透析的高磷血症患者80例,随机分为两组。对照组按制定低磷饮食宣教计划表的统一要求实施健康教育路径管理,实验组在对照组基础上采用基于微信平台的健康教育路径。比较两组的血磷浓度和血磷浓度达标率。结果干预后6个月、 9个月、 12个月,实验组的血磷浓度明显低于对照组(P <0.05)。干预后9个月、 12个月,实验组的血磷浓度达标率明显高于对照组(P <0.05)。结论基于微信平台的健康教育路径对高磷血症血液透析患者的干预效果优于常规干预措施。     

The impact of a nutritional intervention based on egg white for phosphorus control in hemodialyis patients

Background and aims

Here we describe a dietary intervention for hyperphosphatemia in dialysis patients based on the partial replacement of meat and fish, which are one of the main sources of alimentary phosphorous, with egg white, a virtually phosphorous-free protein source. This intervention aims to reduce phosphorous intake without causing protein wasting.