Phosphorus Binders for Hyperphosphatemia Treatment

Phosphorus Binders for Hyperphosphatemia Treatment In the population of 385 individuals that have developed end stage renal disease in the United States, about 250,000 individuals have a condition called hyperphosphatemia (Fink Vincent, 2011, p. 194). This condition is defined by â€Å"a serum phosphate level above 4.5 mg/dL; it may be clinically significant at levels over 5 mg/dL† (Fink Vincent, 2011, p.195). People with kidney disease are not able to filter out phosphorus anymore, therefore resulting in excess amounts of it (Malberti, 2013). Phosphorus in small quantities are good for the body; however, if the level of phosphorus exceeds a certain amount, it can be dangerous because it can deplete calcium, which is essential to the body (Fink Vincent, 2011). An excess results in a gland in the neck to release a hormone which releases calcium out of the bones. Hence, the bones turn weak and brittle, which can eventually lead to bone diseases (National Kidney Foundation, Inc., 2013). Kidney failure leads to increases in ser um levels of phosphorus. In the absence of end-stage renal disease, hyperphosphatamia is treated with â€Å"phosphate excretion using saline infusion (volume diuresis) and diuretic administration† (Fink Vincent, 2011). Drugs used to treat this are oral phosphate binders, since they decrease the absorption of phosphate (Provider Synergies, L.L.C., 2009). In the paper, the different types of phosphorus binders that are used to treat patients with hyperphosphatemia caused by End Stage Renal Disease and how does their chemical composition affect their effectiveness as drug will be explored. A wide range of phosphate binders is currently available for the treatment of hyperphosphatemia in CKD patients. These agents are generally divided into two main classes: calcium-based binders (calcium carbonate and acetate) and calcium-free binders (aluminum hydroxide, lanthanum carbonate, magnesium carbonate) (Malberti 2013). Since current phosphate binders are similar in the effectiveness of lowering serum phosphorus levels, the main considerations are the adverse reactions, gastrointestinal tolerability, absorbability, and cost-effectiveness (Malberti, 2013). Aluminum hydroxide is a potent phosphate binder, but â€Å"concern about skeletal, hematological and neurological toxicity led to a favored use of calcium salts (carbonate and acetate) in the 1990s† C. The KDIGO recommend avoiding long term use of aluminum hydroxide especially in patients with chronic kidney disease stages three to five (Malberti, 2013). Calcium acetate and calcium carbonate are often considered curre nt standard therapy, since they very effectively lower serum phosphorus levels. Thus, these two calcium-containing binders can be considered comparable for efficacy in control of hyperphosphatemia, effects on mineral metabolism restrictions and tolerability (Provider Synergies, L.L.C., 2009). Sevelamer carbonate has shown comparable efficacy and safety to sevelamer hydrochloride in dialysis patients and is indicated to lower serum phosphorus also in hyperphosphatemic chronic kidney diseases stage 3–5 patients not on dialysis (Provider Synergies, L.L.C., 2009). Dose titration of sevelamer can help patients with either chronic kidney disease stages 3–5 reach a high rate of phosphate control (Arroyo et al., 2014). Lanthanum carbonate is a non-calcium-based phosphate binder supplied as a chewable tablet of three dosage strengths (500, 750 and 1,000 mg of elemental lanthanum) that has been shown to be effective in reducing phosphorus in short-term clinical trials (Malberti, 2013). Calcium and aluminum salts are commonly used. Nevertheless, calcium salts can lead to hypercalcemia and metastatic calcification because of high calcium-phosphorus (Ca Ãâ€" PO4) and aluminum salts are very toxic (Malberti, 2013). Chronic management of hyperphosphatamia included treatments with calcium-free phosphate binders like sevelamer hydrochloride [Renagel] which may reduce long-term mortality by preventing the cardiovascular complications that associated with a high Ca Ãâ€" PO4 product (Provider Synergies, L.L.C., 2009). In 2003, the National Kidney Foundation released rules and guidelines about how to manage hyperphosphatemia and bone-related disorders in patients with renal impairment (NIH., 2012). The Kidney Disease Quality Outcome Initiative (NKF-K/DQOIâ„ ¢) states that patients who are on dialysis should have serum phosphorus levels between 3.5 to 5.5 mg/dL (1.13 to 1.78 mmol/L) (National Kidney Foundation, Inc., 2012). Treatment options include â€Å"reduction of di etary phosphorus, phosphate binding therapy, and removal of phosphorus by dialysis† (Provider Synergies, L.L.C., 2009). Magnesium carbonate (MgCO3) is a phosphorus binder with advantages in terms of cost, safety and tolerance and it has a similar efficacy to other drugs. This source assess the effects of replacing aluminum hydroxide [Al(OH3)] with MgCO3to help treat patients with hyperphosphatemia (Malberti, 2013). MgCO3 is another type of phosphorus binder but is not as commonly used as calcium acetate or sevelamer hydrochloride (Malberti, 2013). Twenty- one patients with â€Å"phosphorus 3) as the only binder. Then there was a conversion to MgCO3 â€Å" (Arroyo et al, 2014). Hyperphosphatemia decreased from 4.52 ±0.99 to 4.02 ±1.07mg/ dl (P=.027),. In patients who were previously taking MgCO3allowed good control of serum phosphorus in hemodialysis patients who were previously well controlled with Al(OH3), MgCO3 â€Å"permitted good control of serum phosphorus levels even though there was a slight increase in serum magnesium†, but that had short-term clinical significance (Arroyo et al, 2014). Aluminum hydroxide is a powerful binder and was historically used to treat patients with hyperphosphatemia, but because of its high toxicity levels (Floege et al. 2014). Patients were selected from a hemodialysis unit that had adequate control of serum phosphorus levels and were on Al(OH)3 binder monotherapy and required continuation (Arroyo et al, 2014). A study was conducted that tested the efficiency of a new iron-based phosphate binder. PA21 (sucroferric oxyhydroxide), a â€Å"novel calcium-free polynuclear iron(III)-oxyhydroxide phosphate binder, was compared with that of sevelamer carbonate in randomized, controlled phase III study† (Floege et al. 2014). Seven hundred and seven hemodialysis and peritoneal dialysis patients with hyperphosphatemia received PA21 1.0–3.0à ¢Ã¢â€š ¬Ã¢â‚¬ °g per day and 348 received sevelamer 4.8–14.4à ¢Ã¢â€š ¬Ã¢â‚¬ °g per day for an 8-weeks, followed by 4 weeks without dose change, and then 12 weeks maintenance (Floege et al. 2014). Efficacy was maintained to week 24. â€Å"Mild, transient diarrhea, discolored feces, and hyperphosphatemia were more frequent with PA21; nausea and constipation were more frequent with sevelamer† and he PA21 maintenance dose was superior to the low dose in maintaining serum phosphorus control (Floege et al. 2014). Thus, PA21 was effective in lowering serum phosphorus in dialysis patients, with similar efficacy to sevelamer carbonate, a lower pill burden, and better adherence (Floege et al. 2014). PA21 (sucroferric oxyhydroxide) is a â€Å"new calcium-free polynuclear iron(III)-oxyhydroxide phosphate binder with a high phosphate binding capacity over a wide pH range† (Pennick et al 2012).12 It is formulated as flavored, chewable tablets that disintegrate easily in the gastrointestinal (GI) tract, bind phosphate across the whole physiologically relevant pH range, each contain 500à ¢Ã¢â€š ¬Ã¢â‚¬ °mg of iron, and may be taken without water (Floege et al. 2014). Phosphorus binders decrease the absorption of phosphorus in the gastrointestinal tract (Provider Synergies, L.L.C., 2009). They are â€Å"simple molecular entities but can also be polymeric structures that bind with phosphorus in the body and form an insoluble compound† (Provider Synergies, L.L.C., 2009). Some binders work as a sponge and soak up the phosphorus in foods while others bind to the phosphate and are then excreted (NIH., 2012). Calcium-containing salts are used to bind with phosphorus and to increase calcium levels. The most commonly used calcium containing salt is calcium acetate (PhosLo) (Provider Synergies, L.L.C., 2009). Sevelamer (Renagel, Renvela) is a non-calcium, non-aluminum, non-magnesium, non-absorbable hydrogel that binds phosphorus. Sevelamer comes in two salt forms – sevelamer hydrochloride (Renagel) and sevelamer carbonate (Renvela) (Provider Synergies, L.L.C., 2009). Sevelamer yields the same reduction in serum phosphate levels as calcium ace tate but does not have the same risk of hypercalcemia since it does not contain calcium. Lantanum carbonate (Fosrenol) is another phosphate binder (Provider Synergies, L.L.C., 2009). Lantanum has a high affinity for phosphorus and is part of the lanthanide series. It reacts with phosphorus to form the insoluble compound lanthanum phosphate(Provider Synergies, L.L.C., 2009). When calcium acetate and sevelamer hydrochloride were compared for efficiency, 84 patients were randomized to calcium acetate or sevelamer for eight weeks (Arroyo et al., 2014). A similar result was observed between the calcium acetate and sevelamer (sevelamer -2.0 ±2.3mg/dL versus calcium acetate -2.1 ±1.9 mg/dL) (Arroyo et al., 2014). However, Hypercalcemia (serum calcium >11 mg/dL) was observed in 22 percent of patients receiving calcium acetate (Provider Synergies, L.L.C., 2009). These are the various types of phosphorus binders used to treat patients with hyperphosphatemia caused by End Stage Renal Disea se. The chemical composition affects their cost, toxitity, and how they work inside the body. There are new discoveries as discussed about the iron based phosphorus binder. This type of phosphate binder is being tested further in clinical trials to make it available to the masses.

Research has been done to determine Essay

A lot of research has been done to determine whether short-term memory works better in the morning or afternoon. In a study, 16-18-year-olds (sixth form students of Battersea park school) were administered to take part in a word test to assess their short-term memory. Results of this were analyzed. Null Hypothesis: learning in the morning is more effective Alternative hypothesis: learning in the afternoon is more effective. Introduction To learn new things, to store experiences and to adapt to new circumstances – these characteristics of the brain enable us the daily survival . This special flexibility of the brain is reached through constant making and breaking contact between nerve cells. Whenever we learn something, the connections between nerve cells, (synapses) change. At this point, the Axon of a nerve cell and the Dendrite of the neighbouring cell meet. The centre for brain research of the medical University of Vienna is currently involved in two researches that contribute to the clarification of the processes in memory. They had tested the article (of researchers at the Harvard Medical School), which is called a key experiment. It was found that a Micro RNA and the accompanying messenger RNA exist at the contact point of synapses. What are Micro- and messenger RNA? It is a different form of the Ribonucleic acid. As a messenger RNA (mRNA), one is already more familiar with for a long time: It functions as a messenger, transports a message of the DNA – often, but not always from a gene – out of the cell nucleus into the cytoplasm. There the message is translated often, but not always into a protein. One knows micro RNAs for the least in time: They consist only of 21 bases respectively, and they are not translated into proteins. They rather check an mRNA in that they cause or prevent that the mRNA is translated into a protein. So they are regulators. For example just at a synapse, as long as there a micro RNA on a certain mRNA, it is not translated into a protein. If the micro RNA falls away, the protein emerges – and the synapse changes its form and also the signal forwarding. In other words we can say that the nerve cell learned something. In the journal of Cell Biology (172, p. 221) – Kiebler describes a second factor that is necessary, with a synapse function: Staufen 2: That is a protein that is responsible for the carrying of mRNA along the cell skeleton to the synapse. It brings RNAs to where they are needed. Neurons which are missing the protein Staufen2 have less synapses, and the signal transmission between them is disturbed. â€Å"An important notice on that, is that Staufen 2 for the education of functioning Synapses is crucial†, says Kiebler ( researcher). If what we have learned is forgotten, long-term connections become out of contact of the connection points. German Neurobiologist worked on the correlation between the outgrowing of the connections of cells, the so-called â€Å"thorns† and the building of functioning synapses. In order to be able to follow the outgrowing of thorns, the cells in the near surrounding area of the stimuli were observed using a high resolution two-Photon-microscope. An electron microscope was used in order to review whether the variations in the nerve cells actually led to the origin of new synapses. Within few minutes after the current impulse, the encouraged nerve cells opened the gate to a new discovery. These thin thorns do not grow spontaneously (as they thought), but rather grow towards possible contact partners. Within the first eight hours no piece of information can be exchanged between the newly emerged cell contacts. Not until the following hours it is decides whether a connection remains exist or disappears. For sure, those contacts, that are still available after 24 hours, have fully functioning synapses which can transfer information and have a good chance to exist after several days. Then the reconstruction in the brain is locked evidently. Which parts of the brain remember which type of memory?

Parenting skill Essay

1.How can parents avoid temper tantrums? It having a plan to calm your self down every time you have for example by going to your happy place,relax,and by staying calm at all time 2.What are the A, B, Cs? -A is for the attributes you want your child to have ⠁Æ'B is for the behavior you want to go along with those attributes. ⠁Æ'C is for the consequence that will be given, positive or negative 3. Do you think using consequences and following the ABC process will help shape a child’s behavior? Why or why not? Yes, I think using consequences and following the ABC process will help shape a child’s behavior because it gives the child a set of expectations you want from them and because naturally humans are born to please they are going to try their hardest to live by those expectations you have provided them. 1.What are some of the reasons why people may not talk to babies as much today as they used to? We don’t really know the exact reason why people are not talking to their babies as much some may say it is due to the busy life style we have or that everyone is isolated within the house 2. Why do you think developing language skills is important for a child? Developing language skills as a child is important because when children are younger it is easier for them to learn and develop and they should learn to be good communicators 3.What are some of the ways that parents can encourage the development of language skills? One way parents can help encourage development of language skills is by giving them their undivided attention and contently talking to them because most of their learning is through imitation.

Alcohol Abuse Among Aboriginal Youth - 1781 Words

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Donatelle and Thompson (2011) define alcohol abuse as the excessive consumption or a level of consumption that interferes with work, school, or socia l and family relationships (256). As with other drug addictions, this abuse is disruptive to the alcohol abusers life as well as to those close to them. Moreover, alcohol abuse is accompanied by many devastating effects for all demographics. The harms associated with the misuse and abuse of alcohol includes: harm to oneself, negative effects on friendships and social life, and negative affects to physicalShow MoreRelatedAddiction : The Canadian Aboriginal Community1690 Words   |  7 PagesCanadian Aboriginal community consists of a strong support system founded on tradition, heritage, and spirituality. However, the history of Natives in Canada is polluted with marginalization, abandonment, and powerlessness. 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