Sevelamer carbonate is an improved, buffered form of sevelamer hydrochloride developed for the treatment of hyperphosphatemia in patients with chronic kidney disease. This study investigated the ...ability of sevelamer carbonate to control serum phosphorous in hyperphosphatemic patients who had chronic kidney disease and were not on dialysis.
This was an open-label, dosage-titration study. Patients with serum phosphorus > or =5.5 mg/dl were enrolled (n = 46). Sevelamer carbonate was administered for 8 wk. Patients were supplemented with native vitamin D (400 IU). The primary efficacy parameter was the change from baseline in serum phosphorous. Secondary measures included the percentage of serum phosphorus responders; changes in serum lipids, calcium-phosphorus product, and bicarbonate; and safety and tolerability.
Sevelamer carbonate treatment resulted in a statistically significant decrease in mean serum phosphorous levels from baseline to end of treatment. A total of 75% of patients with stage 4 and 70% of patients with stage 5 chronic kidney disease achieved the target serum phosphorous at the end of treatment. There were statistically significant decreases in serum calcium-phosphorus product and total and low-density lipoprotein cholesterol at the end of treatment and a statistically significant increase in mean serum bicarbonate levels (from 16.6 to 18.2 mEq/L). Sevelamer carbonate was well tolerated.
Sevelamer carbonate is an effective and well-tolerated therapy for the control of phosphorous levels in hyperphosphatemic patients who have chronic kidney disease and are not on dialysis.
Very rapid bone loss, osteopenia and skeletal morbidity after renal transplantation have been well documented and found to occur in a sex dependent fashion. Glucocorticoids, cyclosporine and ...pre-existing uremic osteodystrophy have been implicated in the pathogenesis of the skeletal lesions. Glucocorticoid induced osteopenia is also a serious clinical problem in patients with various nonrenal diseases and can be prevented, or at least attenuated, by pamidronate and other bisphosphonates.
We prospectively studied 26 male patients undergoing renal transplantation, and randomized them to receive either placebo or intravenous pamidronate (0.5 mg/kg) at the time of transplantation and again one month later. All patients received immunosuppression comprising prednisolone, cyclosporine and azathioprine. The bone mineral density (BMD) of the second, third and fourth lumbar vertebrae and of the femoral neck was measured at the time of transplantation and at three months and 12 months after transplantation using dual energy X-ray absorptiometry (DXA).
Twelve months after transplantation, the mean (+/- SEM) BMD of the lumbar vertebrae in patients who received placebo had decreased 6.4% (P < 0.05). In contrast, patients who received pamidronate experienced no significant reduction of BMD at the lumbar vertebrae. At the femoral neck, placebo-treated patients showed a reduction of BMD of 9% (P < 0.005), whereas there was no significant change in the pamidronate treated group. The two study groups had similar patient profiles, serum parathyroid hormone (PTH) and aluminium concentrations. After transplantation, comparable falls in the serum creatinine and PTH concentration were found in the two groups. Apart from transient hypocalcemia in two patients, no significant adverse effects of pamidronate were noted.
This study has shown that the early rapid bone loss that occurs in men during the first 12 months after renal transplantation can be prevented by two intravenous doses of pamidronate given at transplantation and one month later. The regimen was simple to administer, well tolerated and potentially applicable to other clinical groups of glucocorticoid treatment patients.
Department of Renal Medicine and Transplantation, Barts and The
London Hospital NHS Trust, London, United Kingdom
Correspondence to: S. Fan, Department of Renal Medicine and Transplantation,
Barts ...and The London Hospital NHS Trust, Whitechapel, London E1 1BB, United
Kingdom. s.fan{at}qmul.ac.uk
Background: Accurate measurement of ultrafiltration (UF)
is important to improve the morbidity and mortality of peritoneal dialysis
(PD) patients. The introduction of "flush-before-fill" PD systems
has led to improved peritonitis rates. Partly to compensate for dialysate lost
during flush-before-fill, extra dialysate was added to each PD bag. A 2-L PD
bag now contains a mean volume of 2.225 L. That overfill volume might be
erroneously measured as UF. We previously studied how this confounding factor
might be affecting the diagnosis of UF failure and found that almost all units
were overestimating daily UF by 900 mL. We now repeat the study to determine
if the accuracy of UF estimation has improved.
Methods: We conducted a telephone survey of PD units in
the UK to determine how drain bags are weighed and how UF is calculated during
formal assessment of adequacy and the peritoneal equilibrium test (PET). We
also retrospectively analyzed our last 100, 24-hour dialysate collections and
PET results to determine the potential clinical impact of overestimating
UF.
Results: There has been an improvement since our last
study, but 70% of PD units in the UK are still overestimating daily UF in
patients on continuous ambulatory PD (CAPD). Half the surveyed units also
inaccurately calculate UF during the PET, and 85% were reporting results of
PET and 24-hour dialysate collections through the software provided by Baxter
Healthcare. By including the overfill volume, 73% of patients with daily UF
<750 mL would not be diagnosed as having inadequate daily UF (assuming that
all were fluid overloaded and anuric). Similarly, 73% with potential UF
failure during the PET (4-hour UF <100 mL) would be missed if overfill
volume was misrepresented as UF.
Conclusion: For patients undergoing CAPD, there requires
standardization on when drain bags are weighed. Awareness that calculation of
UF must exclude overfill volumes has improved but remains poor. The PD
Adequest software (Baxter Healthcare, Compton, UK) is widely adopted in the UK
and perhaps it could draw attention of users to the potential of UF
overestimation in CAPD patients.
KEY WORDS: Ultrafiltration; ultrafiltration failure; flush-before-fill.
Received 20 May 2005;
accepted 7 September 2005.
Residual renal function is a major survival determinant for peritoneal dialysis patients. Hypovolemia can cause acute kidney injury and loss of residual renal function, and it has been suggested that ...patients receiving peritoneal dialysis should preferably be maintained hypervolemic to preserve residual renal function. Here we determined whether hydration status predicted long-term changes in residual renal function. Changes in residual renal function and extracellular water (ECW) to total body water (TBW) measured by multifrequency bioimpedance in 237 adult patients who had paired baseline and serial 12 monthly measurements were examined. Baseline hydration status (ECW/TBW) was not significantly associated with preservation of residual renal function, unlike baseline and follow-up mean arterial blood pressure. When the cohort was split into tertiles according to baseline hydration status, there was no significant correlation seen between change in hydration status and subsequent loss in residual renal function. Increased ECW/TBW in peritoneal dialysis patients was not associated with preservation of residual renal function. Similarly, increments and decrements in ECW/TBW were not associated with preservation or reduction in residual renal function. Thus, our study does not support the view that overhydration preserves residual renal function and such a policy risks the consequences of persistent hypervolemia.
Nephrology and Transplantation, Barts and The London NHS Trust,
London, United Kingdom
Correspondence to: S.L.S. Fan, Department of Renal Medicine and
Transplantation, Barts and The London Hospital ...NHS Trust, Whitechapel, London
E1 1BB, United Kingdom.
s.fan{at}qmul.ac.uk
Objective: Elevated C-reactive protein (CRP) level is an
independent predictor of all-cause and cardiovascular mortality in peritoneal
dialysis (PD) patients. Statins have been demonstrated to have
anti-inflammatory properties by virtue of their CRP lowering effects in
hemodialysis patients. However, whether statins have an anti-inflammatory
effect in PD patients is unknown.
Design: All prevalent PD patients at our center were
reviewed. Eligible (257) patients were categorized into 2 groups: those on
statin therapy ( n = 137) and those not on statins ( n = 120).
Data were abstracted for hemoglobin, albumin, phosphates, cholesterol, CRP,
Kt/V, and erythropoietin dose, along with relevant clinical data.
Results: The two groups had similar concentrations of
hemoglobin, albumin, and phosphates. They were also matched for dialysis
adequacy and duration of dialysis but the statin group patients were older (57
± 13 vs 52 ± 17 years, p = 0.01). Serum cholesterol was
lower in the statin group (4.74 ± 1.05 vs 5.02 ± 1.17 mmol/L,
p < 0.05). Single-point (14 ± 13 vs 19 ± 18 mg/L,
p < 0.02) and serially measured CRP (9 ± 7.4 vs 12 ±
10 mg/L, p < 0.02) levels were significantly lower in the statin
group despite increased comorbidity (0.84 vs 0.54, p < 0.02) and
greater incidence of diabetes mellitus (52% vs 25%, p < 0.01).
Conclusion: Statin therapy is associated with low
single-point and serially measured CRP levels in PD patients, thereby
suggesting that their anti-inflammatory properties persist in PD. These data
have implications for considering statin therapy in PD patients as an
anti-inflammatory agent in addition to a cholesterol lowering drug.
KEY WORDS: KEY WORDS:; Statins; anti-inflammatory; CRP.
Received 9 September 2005;
accepted 29 December 2006.
Brachyptery in female moths is a common phenomenon. This article examines the eyes of the moth Operophtera brumata, in which only the males have wings. Both sexes possess eyes of the superposition ...type, have facets with corneal nipples, and exhibit eyeglow, but the eye of the male has 2174 facets, measures 725 μm in diameter, and has a clear zone of 112-μm width. That of the female has 1352 facets, measures 557 μm across, and has a 77-μm-wide clear zone. There were no significant differences in rhabdom diameters (10 μm) and tracheal sheath development, but male rhabdoms were significantly longer (85 vs. 65 μm). Dark/light adaptational changes manifested themselves in the positions of the distal screening pigment granules: between the cones during darkness and into the clear zone during light adaptation. The combination of a larger radius of curvature, wider clear zone, and longer rhabdoms gives the males a sensitivity at least twice that of the female. The narrower interommatidial angles of the male (2.8° vs. 3.2°) together with the well-developed tracheal rhabdom sheaths, furthermore, provide the eyes of the males with better resolution. Finally, eye-glow intensity in males diminishes considerably faster in light than it does in females. The differences between males and females appear to reflect their different roles: males begin to search after sunset in and around stands of trees for the pheromone-emitting females, which sit on the trunk of the tree under which they had emerged from their pupal case. Flying males encounter rapid light intensity changes and have to evade obstacles and enemies. The females are considerably more sedentary, but once mated, still seek suitable oviposition sites long after the males have ceased searching for them. During this activity, the females also need visual sensitivity and acuity, but less than the actively flying males.
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