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Indian J Endocrinol Metab 2018 Nov-Dec;22(6):735-739

Department of Biochemistry, GGS Medical College, Faridkot, Punjab, India.

Parathyroid hormone (PTH) is the main regulator of calcium, phosphate, magnesium, sodium, and potassium homeostasis. Therefore, this study was conducted to evaluate the relationship between PTH and aforementioned minerals in end-stage renal disease (ESRD) patients.

Aim: The aim of this study was to estimate serum intact parathormone (iPTH) and other biochemical parameters in ESRD patients and to find correlation between serum iPTH and biochemical parameters in the study group. Read More

Dent J (Basel) 2019 Feb 11;7(1). Epub 2019 Feb 11.

School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.

An association between periodontal disease and cancer has been established in recent studies, but no common etiology has been identified in the hopes of reducing the global burden of these non-communicable diseases. This perspective article hypothesizes that the determinant mediating the association of periodontal disease with cancer is dysregulated phosphate metabolism. Phosphate, an essential dietary micronutrient, is dysregulated in chronic kidney disease, and both cancer and periodontal disease are associated with chronic kidney disease. Read More

Ann Pediatr Cardiol 2019 Jan-Apr;12(1):10-17

Department of Clinical Pathology, Tanta Faculty of Medicine, Tanta, Egypt.

Background: Cardiovascular morbidity (CVM) is the main etiology of mortality in children and adolescents with chronic kidney disease (CKD). CKD associated cardiovascular mortality is more common in children with diastolic cardiac dysfunction which was considered as an early indicator for death, while increased left ventricular mass (LVM) is a strong independent risk factor for these patients. Vitamin D deficiency was previously studied as one of the risk factors for CVM. Read More

Clin Cancer Res 2019 Feb 11. Epub 2019 Feb 11.

Department of Medicine, Memorial Sloan Kettering Cancer Center.

Purpose: To investigate tolerability, efficacy, and pharmacokinetics/-dynamics (PK/PD) of Debio 1347, a selective fibroblast growth factor receptor (FGFR) Inhibitor.

Experimental Design: This was a first-in-human, multicenter, open-label study in patients with advanced solid tumors harboring FGFR1-3 gene alterations. Eligible patients received oral Debio 1347 at escalating doses once daily until disease progression or intolerable toxicity. Read More

J Bras Nefrol 2019 Feb 4. Epub 2019 Feb 4.

NephroCare Lumiar, Lisboa, Portugal.

Introduction: Hyperphosphatemia is a serious consequence of chronic kidney disease and has been associated with an increased risk for cardiovascular disease. Controlling serum phosphorus levels in patients on dialysis is a challenge for the clinicians and implies, in most cases, the use of phosphate binders (PB). Part of the reason for this challenge is poor adherence to treatment because of the high pill burden in this patient group. Read More

J Trace Elem Med Biol 2019 Mar 8;52:1-5. Epub 2018 Nov 8.

Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. Electronic address:

The present study aims to assess arsenic accumulation and explore its association with renal function and biomarkers of CVD risk in chronic kidney disease patients receiving continuous ambulatory peritoneal dialysis (CAPD). The serum was collected from 87 CAPD patients and 26 healthy subjects between 2015 and 2016. The arsenic concentration was measured by inductively coupled plasma mass spectrometer. Read More

Nephron 2019 Feb 7:1-12. Epub 2019 Feb 7.

Department of Molecular Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

Background: Hyperphosphatemia is a major accelerator of complications in chronic kidney disease and dialysis, and phosphate (Pi) binders have been shown to regulate extracellular Pi levels. Research on hyperphosphatemia in mouse models is scarce, and few models display hyperphosphatemia induced by glomerular injury, despite its relevance to human glomerular disease conditions. In this study, we investigated the involvement of hyperphosphatemia in kidney disease progression using a mouse model in which hyperphosphatemia is induced by focal segmental glomerulosclerosis (FSGS). Read More

BMC Nephrol 2019 Feb 4;20(1):37. Epub 2019 Feb 4.

Manchester Academic Health Science Center, Manchester, UK.

Background: Hyperphosphataemia in dialysis subjects is associated with increased mortality. However cause and effect has not been proven, and the ideal phosphate target range is unknown despite KDOQI's call for studies over 12 years ago. The design and conduct of a randomized controlled trial is challenging because maintaining two groups within differing target ranges of serum phosphate has not been achieved over a long follow-up of 1 year, in a trial setting, before. Read More

Am J Case Rep 2019 Feb 3;20:146-150. Epub 2019 Feb 3.

Department of Hemato-Oncology, Chosun University Hospital, Gwangju, South Korea.

BACKGROUND Tumor lysis syndrome (TLS) is an oncologic emergency resulting from the massive destruction of tumor cells after cytotoxic chemotherapy for chemosensitive malignancies with a high tumor burden. Its clinical manifestations include severe electrolyte disturbances, metabolic acidosis, acute renal failure secondary to urate deposition in the kidney, heart, and skeletal muscle, and nervous system dysfunction. We report an extremely rare case of spontaneous TLS (STLS) in idiopathic primary myelofibrosis (PMF). Read More

Ter Arkh 2018 Jun;90(6):48-54

I.M. Sechenov First Moscow State Medical University, Ministry of Health (Sechenov University), Moscow, Russia.

Aim: Aim of the study was to explore the role of the FGF-23/sKlotho/sclerostin ratio disturbance in the determining of cardiovascular risk in end stage renal disease (ESRD) patients, receiving treatment with regular hemodialysis (НD) or hemodiafiltration (НDF) online in Russia.

Materials And Methods: 42 patients with ESRD, at the age of 18-55 years, treated with HD or HDF on line for at least 6 months, were examined. 22 (52. Read More

J Cell Physiol 2019 Jan 31. Epub 2019 Jan 31.

Department of Nephrology, The First Hospital of China Medical University, Shenyang, P. R. China.

Pathological calcification represents an event that consequently leads to a distinct elevation in the morbidity and mortality of patients with chronic kidney disease (CKD) in addition to strengthening its correlation with hyperphosphatemia. Epigenomic regulation by specific microRNAs (miRNAs) is reported to be involved in ectopic calcification. However, the finer molecular mechanisms governing this event remain unclear. Read More

Colomb Med (Cali) 2018 Dec 30;49(4):288-291. Epub 2018 Dec 30.

Complejo Asistencial Universitario de León, Servicio de Nefrología, León, España.

Introduction: Calciphylaxis is an infrequent disease that almost exclusively affects patients with chronic kidney disease, although cases have been observed in patients without renal function impairment. The diagnosis is mainly made by clinical manifestations and subsequently confirmed by radiological and histological study. The optimal treatment is not known, although there is a consensus that a multifactorial approach is required. Read More

Am J Kidney Dis 2019 Jan 24. Epub 2019 Jan 24.

Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address:

Careful dietary management that reduces high phosphate intake is recommended to slow the progression of chronic kidney disease (CKD) and prevent complications of CKD and may help reduce chronic disease risks such as incident CKD associated with high phosphate intake in the healthy general population. For patients treated with maintenance dialysis, control of serum phosphorus levels is considered a marker of good care and requires a coordinated plan that limits dietary phosphate intake, uses oral phosphate binders, and provides an adequate dialysis prescription. Even with traditional thrice-weekly hemodialysis or peritoneal dialysis, use of phosphate binders, and a concerted effort to limit dietary phosphate intake, adequately controlled serum phosphorus levels are not possible in all dialysis patients. Read More

Pflugers Arch 2019 Jan 26. Epub 2019 Jan 26.

Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Fahrstr. 17, D-91054, Erlangen, Germany.

Fibroblast growth factor 23 (FGF23) levels are elevated in patients with acute kidney injury (AKI). The consequences on renal Ca, Mg, and P regulatory mechanisms are unknown. We hypothesized that renal ischemia-reperfusion (I/R) injury alters the expression of important renal Ca, Mg, and P transport proteins. Read More

J Ren Nutr 2019 Jan 21. Epub 2019 Jan 21.

University of California Irvine, School of Medicine, Orange, California. Electronic address:

Objective: The high pill burden of many phosphate binders (PBs) may contribute to increased prevalence of hyperphosphatemia and poor nutritional status observed among patients undergoing maintenance hemodialysis therapy. We examined the real-world effectiveness of sucroferric oxyhydroxide (SO), a PB with low pill burden, in managing serum phosphorus in patients with prevalent hemodialysis over a 1-year period.

Design: Historical cohort analyses of de-identified electronic medical records. Read More

Calcif Tissue Int 2019 Jan 23. Epub 2019 Jan 23.

Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, University of Tokushima Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.

Inorganic phosphate (Pi) is an essential nutrient for maintaining various biological functions, particularly during growth periods. Excess intake of dietary Pi increases the secretion of fibroblast growth factor 23 (FGF23) and parathyroid hormone to maintain plasma Pi levels. FGF23 is a potent phosphaturic factor that binds to the α-klotho/FGFR complex in the kidney to promote excretion of Pi into the urine. Read More

Best Pract Res Clin Endocrinol Metab 2018 Dec 28;32(6):927-939. Epub 2018 Sep 28.

Department of Surgery and Translational Medicine, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, Italy. Electronic address:

The clinical manifestations of hypoparathyroidism are variable and can involve almost any organ system. The main clinical features of the hypoparathyroidism are typically signs or symptoms due to neuromuscular irritability owing to low serum calcium level. In addition to hypocalcemia, hyperphosphatemia can contribute to long-term complications, including extra-skeletal calcifications. Read More

Metabolism 2019 Jan 19. Epub 2019 Jan 19.

Paris Descartes University of Medicine, Necker-Enfants Malades Institute, INSERM U1151, France; Functional Exploration Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France.

Phosphate is a cornerstone of several physiological pathways including skeletal development, bone mineralization, membrane composition, nucleotide structure, maintenance of plasma pH, and cellular signaling. The kidneys have a key role in phosphate homeostasis with three hormones having important functions in renal phosphate handling or intestinal absorption: parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), and 1-25-dihydroxyvitamin D (1,25(OH)2D). FGF23 is mainly synthesized by osteocytes; it is a direct phosphaturic factor that also inhibits 1,25(OH)2D and PTH. Read More

Expert Rev Pharmacoecon Outcomes Res 2019 Jan 21:1-12. Epub 2019 Jan 21.

a Pharmacoepidemiology-Pharmacovigilance, Pharmacy Programme , Department of Life and Health Sciences, School of Science and Engineering , University of Nicosia, Nicosia , Cyprus.

Introduction: End-stage renal disease is associated with significant comorbidity and mortality. Among its implications, hyperphosphatemia constitutes a consistent and independent risk factor. The use of benchmark treatment, low-cost calcium-based binders declined due to a potential calcification effect on coronary arteries. Read More

Exp Ther Med 2019 Jan 28;17(1):863-868. Epub 2018 Nov 28.

Neonatology Department, The First People's Hospital of Jingmen, Jingmen, Hubei 448000, P.R. China.

Vascular calcification (VC) is common in patients with diabetes and/or chronic kidney disease (CKD). It is strongly associated with cardiovascular morbidity and mortality. Hyperphosphatemia caused by CKD induces the transformation of vascular smooth muscle cells (VSMCs) into chondrocytes or osteoblast-like cells. Read More

Front Horm Res 2019 19;51:147-159. Epub 2018 Nov 19.

Pseudohypoparathyroidism (PHP), pseudo-PHP, acrodysostosis, and progressive osseous heteroplasia are heterogeneous disorders characterized by physical findings, differently associated in each subtype, including short bones, short stature, a stocky build, ectopic ossifications (features associated with Albright's hereditary osteodystrophy), as well as laboratory abnormalities consistent with hormone resistance, such as hypocalcemia, hyperphosphatemia, and elevated parathyroid hormone (PTH) and thyroid-stimulating hormone levels. All these disorders are caused by impairments in the cAMP-mediated signal transduction pathway and, in particular, in the PTH/PTHrP signaling pathway: the main subtypes of PHP and related disorders are caused by de novo or autosomal dominantly inherited inactivating genetic mutations, and/or epigenetic, sporadic, or genetic-based alterations within or upstream of GNAS, PRKAR1A, PDE4D, and PDE3A. Here we will review the impressive progress that has been made over the past 30 years on the pathophysiology of these diseases and will describe the recently proposed novel nomenclature and classification. Read More

Front Horm Res 2019 19;51:109-126. Epub 2018 Nov 19.

The regulation of plasma calcium levels is essential for the normal physiologic function of every cell. Parathyroid hormone (PTH) is the principal regulator of serum calcium and phosphate homeostasis. PTH is synthesized and secreted by the parathyroid chief cells in the parathyroid glands primarily in response to a decline in serum calcium levels. Read More

Nephrol Ther 2019 Jan 10. Epub 2019 Jan 10.

NephroCare Tassin-Charcot, 69110 Sainte-Foy-Lès-Lyon, France.

Introduction: Despite a better management of hyperphosphatemia in haemodialysis patients observed during the past years, most of them remain insufficiently treated and exposed to bone and cardiovascular complications that are associated with this biological abnormality. The availability of calcium-free phosphate binders among therapeutical options is confirmed to significantly reduce serum phosphate levels without the risk of excess exposure to calcium. Currently sucroferric oxyhydroxyde (SO) is the only iron-based phosphate binder available in France. Read More

Lancet 2019 01;393(10167):168

Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, India.

Adv Exp Med Biol 2019 Jan 12. Epub 2019 Jan 12.

Department of Pediatrics and Nephrology, Warsaw Medical University, Warsaw, Poland.

The incidence of urolithiasis in infants is unknown. The aim of this study was to investigate clinical characteristics, nutrition, calcium, phosphate, 25-hydroxyvitamin D (25(OH)D), alkaline phosphate, and parathyroid hormone in infants with urolithiasis. There were 32 infants (23 boys and 9 girls) of the mean age of 6. Read More

Pediatr Emerg Care 2019 Jan 7. Epub 2019 Jan 7.

We present a case of a 20-month-old girl who presented to the emergency department with anorexia, progressive weakness, and lethargy who was found to have severe hypercalcemia (20.7 mg/dL) and vitamin D hypervitaminosis. Further questioning revealed that this was secondary to a subacute toxic ingestion of "L'il Critters" calcium and vitamin D3 gummy vitamins that were being administered by the patient's mother multiple times a day for several weeks or even months. Read More

Kidney Res Clin Pract 2018 Dec 31;37(4):420-421. Epub 2018 Dec 31.

Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Suita, Japan.

J Clin Endocrinol Metab 2019 Jan 3. Epub 2019 Jan 3.

Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi.

Context: Patients with hypoparathyroidism are managed with vitamin D and calcium. PTH is an emerging option due to its physiological action. Therefore, it is important to assess the efficacy and shortcomings of conventional therapy. Read More

Semin Nephrol 2019 Jan;39(1):41-56

Division of Nephrology, Department of Medcine, New York Medical College, Valhalla, NY.

Dysregulated mineral metabolism is a nearly universal sequalae of acute kidney injury (AKI). Abnormalities in circulating mineral metabolites observed in patients with AKI include hypocalcemia, hyperparathyroidism, hyperphosphatemia, decreased vitamin D metabolite levels, and increased fibroblast growth factor 23 levels. We review the pathophysiology of dysregulated mineral metabolism in AKI with a focus on calcium, phosphate, parathyroid hormone, and vitamin D metabolites. Read More

J Appl Physiol (1985) 2019 Jan 3. Epub 2019 Jan 3.

Dept. of Medical & Molecular Genetics, Indiana Univ. Sch. of Med., United States.

Diabetic nephropathy (DN) is a primary cause of end-stage renal disease and is becoming more prevalent due to the global rise of type 2 diabetes. A model of DN, the db/db uninephrectomized (db/db-uni) mouse, is characterized by obesity, as well as compromised renal function. This model also manifests defects in mineral metabolism common in DN including hyperphosphatemia, which leads to severe endocrine disease. Read More

J Nephrol 2018 Dec 26. Epub 2018 Dec 26.

Department of Nephrology, Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan, 250014, Shandong, People's Republic of China.

Background: The relationship between oral activated charcoal (OAC) and hyperphosphatemia and vascular calcification is not completely clear. We observed and recorded the effects of OAC on hyperphosphatemia and vascular calcification in stage 3-4 chronic kidney disease (CKD).

Methods: In a randomized controlled study, we included 97 patients with stage 3-4 CKD. Read More

In Vivo 2019 Jan-Feb;33(1):11-16

EST clinic, Hirosaki, Japan

Hyperphosphatemia is a serious complication in patients with chronic kidney disease (CKD), and is associated with more rapid progression as well as higher risk of mortality, and higher rate of cardiovascular disease accidents. CKD patients are usually advised to adopt a low phosphate diet in addition to phosphate-lowering medications, if necessary. However, there is a lack of awareness of the dietary sources of phosphate, especially hidden phosphate intake from phosphate additives in processed foods and carbonated beverages. Read More

Tumori 2018 Dec 23:300891618793817. Epub 2018 Dec 23.

1 Department of Hematology, Kocaeli University School of Medicine, Kocaeli, Turkey.

Background:: Tumor lysis syndrome (TLS) is a potentially fatal complication of cancer therapy characterized by severe electrolyte and metabolic abnormalities such as hyperphosphatemia, hyperkalemia, and hypocalcaemia. TLS usually occurs in aggressive hematologic malignancies such as Burkitt lymphoma and acute leukemia. TLS has rarely been observed in multiple myeloma (MM). Read More

J Ren Nutr 2018 Dec 19. Epub 2018 Dec 19.

Northern Alberta Renal Program, Alberta Health Services, Edmonton, Alberta. Electronic address:

Hyperkalemia and hyperphosphatemia are common metabolic disturbances in chronic kidney disease. Management may include instructions on a low-potassium or low-phosphorus diet, respectively. Low-phosphorus diet teaching includes information on phosphorus additives in addition to naturally occurring phosphorus food sources. Read More

Neth J Med 2018 Dec;76(10):437-441

Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands.

Background: Experience with individualized phosphate replacement is limited in patients with severe hypophosphatemia. This study compares the efficacy and safety of an individualized regimen of serum phosphate < 0.4 mmol/l treatment in ICU patients to patients with moderate hypophosphatemia (0. Read More

ACG Case Rep J 2018 28;5:e83. Epub 2018 Nov 28.

Department of Pathology, Hartford Hospital, Hartford, CT.

Sevelamer carbonate is a commonly prescribed anion-exchange resin administered orally to prevent hyperphosphatemia in patients with chronic kidney disease. We present a rare case of a 33-year-old man with end-stage renal disease and diabetic gastroparesis on sevelamer carbonate, who presented with hematochezia and was found to have rectosigmoid ulcers induced by sevelamer crystals. His hematochezia resolved after switching from sevelamer carbonate to lanthanum carbonate. Read More

Pflugers Arch 2019 Jan 13;471(1):137-148. Epub 2018 Dec 13.

Institute of Physiology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.

The Na-dependent phosphate transporter NaPi-IIa (SLC34A1) is mostly expressed in kidney, whereas NaPi-IIb (SLC34A2) has a wider tissue distribution with prominent expression in the lung and small intestine. NaPi-IIa is involved in renal reabsorption of inorganic phosphate (Pi) from urine, and patients with biallelic inactivating mutations in SLC34A1 develop hypophosphatemia, hypercalcemia, hypercalciuria and nephrocalcinosis, and nephrolithiasis in early childhood. Monoallelic mutations are frequent in the general population and may impact on the risk to develop kidney stones in adulthood. Read More

Eur J Endocrinol 2018 Dec 1. Epub 2018 Dec 1.

B Clarke, Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA, Rochester, United States.

Purpose: To provide practice recommendations for the diagnosis and management of hypoparathyroidism in adults Methods: Key questions pertaining to the diagnosis and management of hypoparathyroidism were addressed following a literature review. We searched PubMed, MEDLINE, EMBASE and Cochrane databases from January 2000 to March 2018 using keywords "hypoparathyroidism, diagnosis, treatment, calcium, PTH, calcidiol, calcitriol, hydrochlorothiazide and pregnancy". Only English language papers involving humans were included. Read More

Pflugers Arch 2019 Jan 7;471(1):53-65. Epub 2018 Dec 7.

Department of Toxicology, Veterinary Faculty, University of Zaragoza, Calle Miguel Servet, 177, E50013, Zaragoza, Spain.

The control of inorganic phosphate homeostasis is mediated through the activity of sodium-coupled Pi transporters located in the intestine, kidneys, and bone. To study these transporters in either the native tissue or after heterologous expression, it is very important to use specific inhibitors of the studied transporter, in order to know the corresponding relevance in the total Pi uptake and to differentiate from the activity of other transporters. Inhibitors are also necessary as drugs for treating Pi homeostasis disorders. Read More

J Bras Nefrol 2018 Sep 21. Epub 2018 Sep 21.

Fundação Pró-Rim, Joinville, SC, Brasil.

Introduction: Hyperphosphatemia is associated with unfavorable outcomes, and the percentage of patients presenting with this condition in hemodialysis (HD) in kidney foundation units in the state of Santa Catarina (SC) is historically higher than that of patients in the state of Tocantins (TO).

Objective: To assess the frequency of consumption of the main dietary sources of phosphorus and to compare them between the two states.

Methodology: A cross-sectional study was carried out involving 123 patients, 66 of SC and 57 of TO: 52% were men, average age was 46. Read More

Expert Rev Clin Pharmacol 2018 Dec 2. Epub 2018 Dec 2.

a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt.

Introduction: Uremic syndrome of chronic kidney disease (CKD) is a term used to describe clinical, metabolic and hormonal abnormalities associated with progressive kidney failure. It is a rapidly growing public health problem worldwide. Nervous system complications occur in every patient with uremic syndrome of CKD. Read More

Nutrients 2018 Dec 3;10(12). Epub 2018 Dec 3.

Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.

In chronic kidney disease (CKD), hyperphosphatemia induces fibroblast growth factor-23 (FGF-23) expression that disturbs renal 1,25-dihydroxy vitamin D (1,25D) synthesis; thereby increasing parathyroid hormone (PTH) production. FGF-23 acts on the parathyroid gland (PTG) to increase 1α-hydroxylase activity and results in increase intra-gland 1,25D production that attenuates PTH secretion efficiently if sufficient 25D are available. Interesting, calcimimetics can further increase PTG 1α-hydroxylase activity that emphasizes the demand for nutritional vitamin D (NVD) under high PTH status. Read More

Chin Med J (Engl) 2018 Dec;131(23):2792-2799

Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing 100034, China.

Background: Hyperphosphatemia is a risk factor associated with mortality in patients on maintenance hemodialysis. Gut absorption of phosphate is the major source. Recent studies indicated that the intestinal flora of uremic patients changed a lot compared with the healthy population, and phosphorus is an essential element of bacterial survival and reproduction. Read More

Arch Pathol Lab Med 2018 Nov 30. Epub 2018 Nov 30.

From the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis.

Tumor lysis syndrome (TLS) is an acute, life-threatening disease among adults and children that is associated with the initiation of cytoreductive therapy in the treatment of malignancy. A pattern of metabolic derangements occurs as a result of a massive release of intracellular contents into the systemic circulation. Characteristic findings include hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia, and uremia, all of which can lead to cardiac arrhythmia, seizures, renal failure, and sudden death. Read More

Clin Calcium 2018;28(12):1611-1618

Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine/The Institute of Medical Sciences, Tokai University, Isehara, Japan.

In patients with chronic kidney disease(CKD), mineral metabolism abnormalities such as hyperphosphatemia, decreased 1,25-dihydroxyvitamin D, and elevated parathyroid hormone develop as kidney function declines, which lead to vascular calcification and a variety of skeletal abnormalities, collectively termed renal osteodystrophy. Because CKD patients have increased risk of bone fractures, it is important to assess fracture risk by measuring bone mineral density and bone metabolism markers. In addition to management of secondary hyperparathyroidism, medications for osteoporosis could be a reasonable option for preventing fracture. Read More

Asia Pac J Clin Nutr 2018 ;27(6):1207-1215

Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Israel.

Background And Objectives: The potential side effects of common phosphate binders are gastrointestinal in practice. We hypothesized that regular use of phosphate binders may be associated with decreased appetite, dietary intake and consequently, poor nutritional status.

Methods And Study Design: This was cross-sectional study of 78 patients (mean age 67. Read More

Curr Opin Nephrol Hypertens 2019 Jan;28(1):34-39

Division of Nephrology, St. Joseph's Healthcare Hamilton, McMaster University.

Purpose Of Review: Phosphate lowering toward the normal range is advocated and widely practiced in patients with end-stage renal disease receiving dialysis. This approach is guided by basic science data and large observational studies that have demonstrated a consistent association between hyperphosphatemia and adverse events, including cardiovascular morbidity and all-cause mortality. There has never been a clinical trial to assess the efficacy of phosphate lowering in maintenance dialysis recipients. Read More

Nephrol Ther 2018 Nov;14(6S):6S17-6S25

Service de néphrologie, hôpital Necker-Enfants malades, 149, rue de Sèvres 75015 Paris, France. Electronic address:

Metabolic complications of chronic kidney disease (CKD) are frequent; the aims of this review are to present a 2018 update for hyperkalemia, hyperphosphatemia and anemia. Hyperkalemia is defined by a plasma level above 5.0 mmol/L, after ruling out pre-analytical problems such as hemolysis. Read More

J Nephrol 2019 Feb 21;32(1):93-100. Epub 2018 Nov 21.

Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.

Aims: Cardiovascular (CV) complications are common in chronic kidney disease (CKD). Numerous metabolic disturbances including hyperphosphatemia, high circulating calciprotein particles (CPP), hyperparathyroidism, metabolic acidosis, and magnesium deficiency are associated with, and likely pathogenic for CV complications in CKD. The goal of this feasibility study was to determine whether effervescent calcium magnesium citrate (EffCaMgCit) ameliorates the aforementioned pathogenic intermediates. Read More

Nutr Metab Cardiovasc Dis 2019 01 28;29(1):45-50. Epub 2018 Sep 28.

Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology, Federico II University of Naples, Italy; Federico II University Hospital, Naples, Italy.

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.

Patients And Methods: As many as 23 hyperphosphatemic patients (15 male and 8 female, mean age 53. Read More