CKD: Hyperphosphatemia (2010)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
To review clinical algorithms on renal osteodystrophy.
Inclusion Criteria:
Article inclusion criteria not specifically mentioned.
Exclusion Criteria:
Article exclusion criteria not specifically mentioned.
Description of Study Protocol:

Recruitment:  article selection methods not described

Design:  Consensus Report

Blinding Used (if applicable):  not applicable

Intervention (if applicable):  not applicable

Statistical Analysis:  statistical analysis not completed

Data Collection Summary:

Timing of Measurements  Not applicable

Dependent Variables:  Not applicable

Independent Variables:  Not applicable

Control Variables:  Not applicable

Description of Actual Data Sample:

Initial N:  92 references

Attrition (final N):  92

Age:  not mentioned

Ethnicity:  not mentioned

Other relevant demographics:

Anthropometrics:

Location:  worldwide studies

Summary of Results:

Pathogenesis of renal osteodystrophy

1. As creatinine clearance decreases , iPTH and serum phosphorus increase, and serum calcium and 1,25(OH)2D decreases.

2. Prevention and/or treatment include calcium supplements to increase serum calcium, phosphate binders to decrease serum phosphate, and dietary counseling to limit dietary intake of phosphate.

3. As the disease progresses, active vitamin D (cholecalciferol) needs to be added to the regime.

Recommended lab values in CRI

Serum

Acceptable Range

Calcium, mg/dl

8.8-11.0

Phosphorus, mg/dl

2.5-4.6

PTH, pg/ml

85-170

Author Conclusion:

1. Calcium: to properly interpret total calcium as in indirect measure of ionized calcium, serum albumin and blood pH need to be analyzed.

2. Chronic metabolic acidosis can lead to increased bone resorption. If present treat metabolic acidosis initially with increased doses of calcium carbonate, add sodium bicarbonate orally if calcium carbonate is inadequate.

3. iPTH should be <18 pmol/L until ESRD.

4. As alkaline phosphatase increases, measure liver enzymes to differentiate source.

5. Check serum calcium after 4 to 6 wks for patients at risk for hypocalcemia: those with vitamin D deficiency (no exposure to the sun, elderly, or those treated with increased doses of diuretics).

6. Dietary counseling should emphasize adequate protein/kcal and calcium while avoiding excess protein and phosphorus.

Funding Source:
Reviewer Comments:

This paper includes a nice algorithm for preventing renal osteodystrophy in early renal disease.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes