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1.
Circulation ; 139(11): 1422-1434, 2019 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-30612451

RESUMO

BACKGROUND: Inorganic phosphate (Pi) is used extensively as a preservative and a flavor enhancer in the Western diet. Physical inactivity, a common feature of Western societies, is associated with increased cardiovascular morbidity and mortality. It is unknown whether dietary Pi excess contributes to exercise intolerance and physical inactivity. METHODS: To determine an association between Pi excess and physical activity in humans, we assessed the relationship between serum Pi and actigraphy-determined physical activity level, as well as left ventricular function by cardiac magnetic resonance imaging, in DHS-2 (Dallas Heart Study phase 2) participants after adjusting for relevant variables. To determine direct effects of dietary Pi on exercise capacity, oxygen uptake, serum nonesterified fatty acid, and glucose were measured during exercise treadmill test in C57/BL6 mice fed either a high-Pi (2%) or normal-Pi (0.6%) diet for 12 weeks. To determine the direct effect of Pi on muscle metabolism and expression of genes involved in fatty acid metabolism, additional studies in differentiated C2C12 myotubes were conducted after subjecting to media containing 1 to 3 mmol/L Pi (pH 7.0) to simulate in vivo phosphate conditions. RESULTS: In participants of the DHS-2 (n=1603), higher serum Pi was independently associated with reduced time spent in moderate to vigorous physical activity ( P=0.01) and increased sedentary time ( P=0.004). There was no association between serum Pi and left ventricular ejection fraction or volumes. In animal studies, compared with the control diet, consumption of high-Pi diet for 12 weeks did not alter body weight or left ventricular function but reduced maximal oxygen uptake, treadmill duration, spontaneous locomotor activity, fat oxidation, and fatty acid levels and led to downregulation of genes involved in fatty acid synthesis, release, and oxidation, including Fabp4, Hsl, Fasn, and Pparγ, in muscle. Similar results were recapitulated in vitro by incubating C2C12 myotubes with high-Pi media. CONCLUSIONS: Our data demonstrate a detrimental effect of dietary Pi excess on skeletal muscle fatty acid metabolism and exercise capacity that is independent of obesity and cardiac contractile function. Dietary Pi may represent a novel and modifiable target to reduce physical inactivity associated with the Western diet.


Assuntos
Metabolismo Energético/efeitos dos fármacos , Tolerância ao Exercício/efeitos dos fármacos , Ácidos Graxos/metabolismo , Músculo Esquelético/efeitos dos fármacos , Fosfatos/efeitos adversos , Fósforo na Dieta/efeitos adversos , Animais , Linhagem Celular , Metabolismo Energético/genética , Exercício , Tolerância ao Exercício/genética , Regulação da Expressão Gênica , Humanos , Masculino , Camundongos Endogâmicos C57BL , Mitocôndrias Musculares/efeitos dos fármacos , Mitocôndrias Musculares/metabolismo , Músculo Esquelético/metabolismo , Consumo de Oxigênio , Fosfatos/administração & dosagem , Fosfatos/metabolismo , Fósforo na Dieta/administração & dosagem , Fósforo na Dieta/metabolismo , Comportamento Sedentário
2.
Nutr Metab Cardiovasc Dis ; 29(1): 45-50, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30459073

RESUMO

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 53.0 ± 10.0 years) on chronic standard 4 h, three times weekly, bicarbonate hemodialysis were enrolled in this open-label, randomized controlled trial. Patients in the intervention group were instructed to replace fish or meat with egg white in three meals a week for three months whereas diet was unchanged in the control group. RESULTS: Serum phosphate concentrations were significantly lower in the intervention group than in controls after three (4.9 ± 1.0 vs 6.6 ± 0.8; p < 0.001) but not after one month of treatment. Phosphate concentrations decreased more from baseline in the intervention than in the control group both after one (-1,2 ± 1,1 vs 0,5 ± 1,1; p = 0.004) and after three (-1,7 ± 1,1 vs -0,6 ± 1,1; p < 0.001) months of follow-up. No change either in body weight or in body composition assessed with bioelectrical impedance analysis or in serum albumin concentration was observed in either group. CONCLUSION: The partial replacement of meat and fish with egg white induces a significant decrease in serum phosphate without causing protein malnutrition and could represent a useful instrument to control serum phosphate levels in hemodialysis patients. CLINICALTRIALS. GOV IDENTIFIER: NCT03236701.


Assuntos
Proteínas Dietéticas do Ovo/administração & dosagem , Hiperfosfatemia/dietoterapia , Carne/efeitos adversos , Fósforo na Dieta/efeitos adversos , Diálise Renal , Insuficiência Renal Crônica/terapia , Alimentos Marinhos/efeitos adversos , Adulto , Composição Corporal , Proteínas Dietéticas do Ovo/efeitos adversos , Feminino , Humanos , Hiperfosfatemia/sangue , Hiperfosfatemia/diagnóstico , Hiperfosfatemia/etiologia , Itália , Masculino , Pessoa de Meia-Idade , Fósforo na Dieta/sangue , Desnutrição Proteico-Calórica/etiologia , Desnutrição Proteico-Calórica/prevenção & controle , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Fatores de Tempo , Resultado do Tratamento
3.
Nutrients ; 10(10)2018 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-30322116

RESUMO

The effect of dietary phosphorus (P) on fibroblast growth factor 21 (FGF21)/ß-klotho axis was investigated in rats that were fed diets with: Normal (NP) or high P (HP) and either normal (NC), high (HC) or low calories (LC). Sampling was performed at 1, 4 and 7 months. Plasma FGF21 concentrations were higher (p < 0.05) in NC and HC than in LC groups. Increasing P intake had differing effects on plasma FGF21 in rats fed NC and HC vs. rats fed LC at the three sampling times. When compared with the NP groups, FGF21 concentrations decreased at the three sampling points in rats fed NC-HP (80 vs. 194, 185 vs. 382, 145 vs. 403 pg/mL) and HC-HP (90 vs. 190, 173 vs. 353, 94 vs. 434 pg/mL). However, FGF21 did not decrease in rats fed LC-HP (34 vs. 20, 332 vs. 164 and 155 vs. 81 pg/mL). In addition, LC groups had a much lower liver FGF21 messenger ribonucleic acid/glyceraldehyde 3-phosphate dehydrogenase (mRNA/GAPDH) ratio (0.51 ± 0.08 and 0.56 ± 0.07) than the NC-NP (0.97 ± 0.14) and HC-NP (0.97 ± 0.22) groups. Increasing P intake reduced liver FGF21 mRNA/GAPDH in rats fed NC and HC to 0.42 ± 0.05 and 0.37 ± 0.04. Liver ß-klotho mRNA/GAPDH ratio was lower (p < 0.05) in LC groups (0.66 ± 0.06 and 0.59 ± 0.10) than in NC (1.09 ± 0.17 and 1.03 ± 0.14) and HC (1.19 ± 0.12 and 1.34 ± 0.19) groups. A reduction (p < 0.05) in ß-klotho protein/α-tubulin ratio was also observed in LC groups (0.65 ± 0.05 and 0.49 ± 0.08) when compared with NC (1.12 ± 0.11 and 0.91 ± 0.11) and HC (0.93 ± 0.17 and 0.87 ± 0.09) groups. In conclusion ß-klotho is potently regulated by caloric restriction but not by increasing P intake while FGF21 is regulated by both caloric restriction and increased P intake. Moreover, increased P intake has a differential effect on FGF21 in calorie repleted and calorie depleted rats.


Assuntos
Restrição Calórica , Fatores de Crescimento de Fibroblastos/sangue , Fósforo na Dieta/efeitos adversos , Fenômenos Fisiológicos da Nutrição Animal , Animais , Biomarcadores/sangue , Regulação para Baixo , Fatores de Crescimento de Fibroblastos/genética , Glucuronidase/genética , Glucuronidase/metabolismo , Fígado/metabolismo , Modelos Animais , Estado Nutricional , Ratos Wistar
5.
Rev Gaucha Enferm ; 39: e20170081, 2018 Jul 23.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30043941

RESUMO

OBJECTIVE: To analyze the association between the occurrence of pruritus and adherence to the prescribed diet, biochemical indicators of renal function and the quality of hemodialysis in chronic renal patients. METHOD: A cross-sectional study performed at a dialysis clinic in the Northeast of Brazil, with 200 patients undergoing hemodialysis in the first half of 2015.To analyze the data, inferential statistics were used, using Chi-Square and Fisher's Exact tests; and Mann Whitney U test. RESULTS: The pruritus was present in 51% of the sample, being associated statistically with phosphorus consumption (P = 0.024) and elevation of serum calcium (P = 0.009). CONCLUSION: Pruritus in chronic renal patients undergoing hemodialysis is influenced by adequate nonadherence to the prescribed diet, in addition to the elevation of biochemical indicators of renal function.


Assuntos
Cálcio/sangue , Falência Renal Crônica/complicações , Fósforo na Dieta/efeitos adversos , Fósforo/sangue , Prurido/etiologia , Diálise Renal , Adulto , Idoso , Terapia Combinada , Estudos Transversais , Dieta com Restrição de Proteínas , Dieta Hipossódica , Exantema/sangue , Exantema/etiologia , Feminino , Humanos , Hipercalcemia/complicações , Hiperparatireoidismo Secundário/complicações , Falência Renal Crônica/sangue , Falência Renal Crônica/dietoterapia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Prurido/sangue , Qualidade de Vida , Diálise Renal/enfermagem , Fatores Socioeconômicos
7.
Biochim Biophys Acta Rev Cancer ; 1869(2): 303-309, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29684520

RESUMO

In this article, we briefly summarized evidence that cellular phosphate burden from phosphate toxicity is a pathophysiological determinant of cancer cell growth. Tumor cells express more phosphate cotransporters and store more inorganic phosphate than normal cells, and dysregulated phosphate homeostasis is associated with the genesis of various human tumors. High dietary phosphate consumption causes the growth of lung and skin tumors in experimental animal models. Additional studies show that excessive phosphate burden induces growth-promoting cell signaling, stimulates neovascularization, and is associated with chromosome instability and metastasis. Studies have also shown phosphate is a mitogenic factor that affects various tumor cell growth. Among epidemiological evidence linking phosphate and tumor formation, the Health Professionals Follow-Up Study found that high dietary phosphate levels were independently associated with lethal and high-grade prostate cancer. Further research is needed to determine how excessive dietary phosphate consumption influences initiation and promotion of tumorigenesis, and to elucidate prognostic benefits of reducing phosphate burden to decrease tumor cell growth and delay metastatic progression. The results of such studies could provide the basis for therapeutic modulation of phosphate metabolism for improved patient outcome.


Assuntos
Transformação Celular Neoplásica/induzido quimicamente , Neoplasias/induzido quimicamente , Fosfatos/efeitos adversos , Fósforo na Dieta/efeitos adversos , Animais , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Transformação Celular Neoplásica/metabolismo , Transformação Celular Neoplásica/patologia , Homeostase , Humanos , Metástase Neoplásica , Neoplasias/metabolismo , Neoplasias/patologia , Proteínas de Transporte de Fosfato/metabolismo , Fosfatos/metabolismo , Fósforo na Dieta/metabolismo , Transdução de Sinais/efeitos dos fármacos
9.
J Anim Physiol Anim Nutr (Berl) ; 102 Suppl 1: 31-36, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29623690

RESUMO

There is evidence that nutritional phosphorus (P) excess may be a risk factor for chronic kidney disease (CKD) in humans and pets (Advances in Nutrition: An International Review Journal (2014), 5, 104; The American Journal of Clinical Nutrition, (2013), 98, 6; Journal of Feline Medicine and Surgery, (2017); The source of phosphorus influences serum PTH, apparent digestibility and blood levels of calcium and phosphorus in dogs fed high phosphorus diets with balanced Ca/P ratio. Proc. Waltham International Nutritional Sciences Symposium, USA; Clinical aspects of natural and added phosphorus in foods, 2017, Springer Science+Business, Media). A retrospective study was conducted in order to gather data about P and protein intake in the feeding history of dogs and cats prior to the diagnosis of CKD. Cases of 75 dogs and 16 cats with CKD with comprehensive nutritional history presented to the nutrition consultation service of the Chair of Animal Nutrition and Dietetics, Ludwig-Maximilians-University Munich, between October 2009 and March 2016, were evaluated. Cases of age-matched dogs (n = 57) and cats (n = 18) without diagnosed or suspected CKD served as controls. The most frequent type of diet used in the four groups (cats CKD, cats control, dogs CKD and dogs control) was home-made. In all groups, P and protein supply was in excess (>150%) of the recommended daily allowances (RDA; Nutrient requirements of dogs and cats (2006), National Research Council, National Academy Press). Between the dog groups, no differences regarding P and protein intake existed. The P and protein intake relative to the RDA was altogether higher in cats than in dogs. Cats with CKD showed significantly higher P and protein intakes prior to diagnosis than the control cats (170 ± 36 vs. 123 ± 34 mg P/kg BW0.67 ; p < .05). These observations call for further investigations into the long-term effects of P excess.


Assuntos
Doenças do Gato/etiologia , Proteínas na Dieta/efeitos adversos , Doenças do Cão/etiologia , Fósforo na Dieta/efeitos adversos , Insuficiência Renal Crônica/veterinária , Animais , Gatos , Cães , Fósforo na Dieta/administração & dosagem , Recomendações Nutricionais , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Fatores de Risco
10.
Nutrients ; 10(3)2018 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-29562658

RESUMO

Coronary artery calcification (CAC) is a widespread condition in chronic kidney disease (CKD). Diet may play an important role in CAC, but this role is not clear. This study evaluated the association between macro-and micronutrient intakes and CAC in non-dialysis CKD patients. We analyzed the baseline data from 454 participants of the PROGREDIR study. Dietary intake was evaluated by a food frequency questionnaire. CAC was measured by computed tomography. After exclusion of participants with a coronary stent, 373 people remained for the analyses. The highest tertile of CAC was directly associated with the intake of phosphorus, calcium and magnesium. There was a higher intake of pantothenic acid and potassium in the second tertile. After adjustments for confounding variables, the intake of pantothenic acid, phosphorus, calcium and potassium remained associated with CAC in the generalized linear mixed models. In order to handle the collinearity between these nutrients, we used the LASSO (least absolute shrinkage and selection operator) regression to evaluate the nutrients associated with CAC variability. In this approach, the nutrients that most explained the variance of CAC were phosphorus, calcium and potassium. Prospective studies are needed to confirm these findings and assess the role of interventions regarding these micronutrients on CAC prevention and progression.


Assuntos
Doença da Artéria Coronariana/etiologia , Dieta/efeitos adversos , Insuficiência Renal Crônica/complicações , Calcificação Vascular/etiologia , Idoso , Brasil , Cálcio na Dieta/efeitos adversos , Distribuição de Qui-Quadrado , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Magnésio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Análise Multivariada , Ácido Pantotênico/efeitos adversos , Fósforo na Dieta/efeitos adversos , Insuficiência Renal Crônica/diagnóstico , Fatores de Risco , Inquéritos e Questionários , Calcificação Vascular/diagnóstico por imagem
11.
Kidney Int ; 93(5): 1060-1072, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29580635

RESUMO

Hyperphosphatemia has consistently been shown to be associated with dismal outcome in a wide variety of populations, particularly in chronic kidney disease (CKD). Compelling evidence from basic and animal studies elucidated a range of mechanisms by which phosphate may exert its pathological effects and motivated interventions to treat hyperphosphatemia. These interventions consisted of dietary modifications and phosphate binders. However, the beneficial effects of these treatment methods on hard clinical outcomes have not been convincingly demonstrated in prospective clinical trials. In addition, exposure to high amounts of dietary phosphate may exert untoward actions even in the absence of overt hyperphosphatemia. Based on this concept, it has been proposed that the same interventions used in CKD patients with normal phosphate concentrations be used in the presence of hyperphosphatemia to prevent rise of phosphate concentration and as an early intervention for cardiovascular risk. This review describes conceptual models of phosphate toxicity, summarizes the evidence base for treatment and prevention of hyperphosphatemia, and identifies important knowledge gaps in the field.


Assuntos
Quelantes/uso terapêutico , Hiperfosfatemia/prevenção & controle , Hiperfosfatemia/terapia , Fosfatos/sangue , Insuficiência Renal Crônica/terapia , Comportamento de Redução do Risco , Animais , Biomarcadores/sangue , Quelantes/efeitos adversos , Humanos , Hiperfosfatemia/sangue , Hiperfosfatemia/epidemiologia , Fósforo na Dieta/efeitos adversos , Fósforo na Dieta/sangue , Recomendações Nutricionais , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Resultado do Tratamento
12.
Ren Fail ; 40(1): 15-21, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29295646

RESUMO

BACKGROUND: This study investigated the therapeutic effect of intensive phosphorus-lowering therapy on intact-parathyroid hormone (iPTH) levels in hemodialysis patients. METHODS: Ninety-five hemodialysis patients with serum phosphorus ≥1.78 mmol/L and iPTH ≥300 pg/dL were apportioned to either the treatment or control group (n = 43 and 52, respectively) based on patient commitment to treatment. The treatment group was given phosphorus-lowering therapies with phosphate binders (lanthanum, sevelamer or/and calcium reagent) combined with dietary phosphate restriction and intensified hemodialysis. The control individuals were given low doses of calcium agents, if serum calcium was <2.54 mmol/L. Percent changes in serum phosphorus and iPTH levels were compared between the two groups. In addition, based on the time required to achieve >20% decrease in serum phosphorus, the patients in the treatment group were further stratified as rapid responders (≤2 months; 27 patients) or slow responders (>2 months; 16 patients) and percent changes in iPTH were compared. RESULTS: Serum phosphorus and iPTH levels decreased from baseline in the treatment group (-24.08 ± 1.93% and -9.92 ± 3.70%, respectively) but increased in the control group (22.00 ± 3.63% and 104.21 ± 23.89%; both p < .001). In the rapid responders subgroup, the iPTH decreased (-16.93 ± 3.49%), but in the slow responders subgroup the iPTH increased slightly (0.68 ± 7.37%, p < .05). CONCLUSIONS: For these patients on maintenance hemodialysis, intensive treatment of hyperphosphatemia was associated with a decrease in iPTH levels, especially for those who had achieved substantial reduction in serum phosphorus within 2 months.


Assuntos
Quelantes/uso terapêutico , Hiperfosfatemia/tratamento farmacológico , Falência Renal Crônica/terapia , Hormônio Paratireóideo/sangue , Diálise Renal/efeitos adversos , Cálcio/sangue , Feminino , Humanos , Hiperfosfatemia/sangue , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , Fosfatos/sangue , Fósforo na Dieta/efeitos adversos , Estudos Prospectivos
13.
Nephrology (Carlton) ; 23(12): 1107-1115, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29064141

RESUMO

AIM: Patients with progressive chronic kidney disease (CKD) develop positive phosphate balance that is associated with increased cardiovascular risk and mortality. Modification of dietary phosphate is a commonly used strategy to improve outcomes but is complicated by the need for adequate dietary protein. Surprisingly, the evidence for patient-level benefits from phosphate restriction is tenuous, and the justification for using any phosphate binder for pre-dialysis patients is questionable. METHODS: The evidence for dietary phosphate modification was reviewed, along with the possible role of a smart phone application (app) that provides information on phosphate, sodium, potassium and nutrients in over 50 000 Australian foods. A pilot study of healthy participants assigned to dietetic advice and standard diet sheets, or dietetic advice, diet sheets and use of the smart phone app was performed. RESULTS: Following baseline studies, 25 participants commenced the sodium and phosphate restricted diet. After 2 weeks, both groups showed non-significant trends to reduction in urinary phosphate and sodium. App users referred to information on the app more frequently than the control group participants referred to written instructions, found referring to the app more convenient, felt they learned more new information, were more motivated to maintain the diet and were more likely to recommend their information source to family or friends (all P < 0.05). CONCLUSIONS: Maintaining phosphate balance remains an important goal of CKD management, although diets incorporating very low phosphate and protein contents may worsen patient outcomes. For selected patients, a smart phone app may improve dietary acceptance and compliance.


Assuntos
Rim/fisiopatologia , Aplicativos Móveis , Fósforo na Dieta/administração & dosagem , Insuficiência Renal Crônica/dietoterapia , Telemedicina/instrumentação , Adulto , Dieta Hipossódica , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Rim/metabolismo , Masculino , New South Wales , Estado Nutricional , Educação de Pacientes como Assunto , Fósforo na Dieta/efeitos adversos , Fósforo na Dieta/urina , Projetos Piloto , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/urina , Smartphone , Fatores de Tempo , Resultado do Tratamento , Equilíbrio Hidroeletrolítico , Adulto Jovem
14.
Clin Nutr ; 37(5): 1625-1630, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-28818343

RESUMO

Phosphorus is an essential nutrient; the adult recommended daily intake ranges from 550 to 700 mg/day, with a tolerated upper limit of 4000 mg/day. Phosphorus intake has increased in the general population in recent years, and simultaneously an alarming rise of type 2 diabetes incidences has been observed. No study has investigated the relationship between phosphorus intake and the risk of type 2 diabetes. To evaluate the association between phosphorus intake and incidence of type 2 diabetes. Among 71,270 women from the French E3N-EPIC cohort, 1845 cases of incident type 2 diabetes were validated during follow-up (1993-2011). Adjusted Cox proportional hazards regression models were used to calculate hazard ratios and 95% confidence intervals (95% CI) for the associations between phosphorus intake and type 2 diabetes risk, adjusted on potential confounders. The overall mean (±SD) phosphorus intake was 1477 mg/day (±391 mg/day). High phosphorus intake was associated with risk of type 2 diabetes. In multivariate models, compared with women in the 1st quartile of phosphorus intake (<1203 mg/day), those included in the 2nd (1203-1434.0 mg/day), 3rd (1434-1700 mg/day), and 4th (>1700 mg/day) were at a higher risk of type 2 diabetes, with a hazards ratios (95% CI) of 1.18 (1.00-1.38), 1.41 (1.20-1.66) and 1.54 (1.25-1.90), respectively. Our results may have important public health implications for dietary recommendations in the prevention of type 2 diabetes. More studies are warranted to better understand the biological mechanisms underlying this positive association.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Fósforo na Dieta/administração & dosagem , Fósforo na Dieta/efeitos adversos , Estudos de Coortes , Dieta , Dieta Ocidental , Feminino , Manipulação de Alimentos , França/epidemiologia , Humanos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
15.
BMJ Open ; 7(8): e016682, 2017 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-28790041

RESUMO

OBJECTIVES: While maintenance of both phosphorus concentration and nutritional status is a major concern in managing haemodialysis patients, the interaction between these parameters is not well understood. The aim of this study was to assess whether or not nutritional index influences the association between phosphorus concentration and all-cause mortality. DESIGN: A cohort study. SETTING: The Dialysis Outcomes and Practice Pattern Study, which included 99 representative dialysis facilities in Japan between 1997 and 2010. PARTICIPANTS: A total of 6230 adult haemodialysis patients who had spent at least 6 months on haemodialysis. MAIN PREDICTORS: Six categories based on time-averaged factors of the geriatric nutritional risk index (GNRI; the lowest two and highest tertiles) and phosphorus concentration (<3.5, 3.5 to <6 and ≥6 mg/dL). PRIMARY OUTCOME MEASURE: All-cause mortality rate. ANALYSIS: Time-dependent Cox regression adjusting for potential confounders. RESULTS: During the follow-up period (12 294 person-years), we noted 561 deaths (4.6 per 100 person-years), and both high phosphorus concentrations and low-middle GNRI were separately associated with all-cause mortality. The harmful effect of high phosphorus concentrations on all-cause mortality was stronger in patients with high GNRI than in those with low-middle GNRI. On the other hand, the harmful effect of low phosphorus concentrations was stronger in those with low-middle GNRI than in those with high GNRI. Relative excess risk due to interaction (RERI) between high phosphorus concentrations and low-middle GNRI was -0.57, indicating an antagonistic interaction. We also observed a significant statistical multiplicative interaction between phosphorus concentrations and GNRI (p=0.05 by likelihood ratio test). CONCLUSIONS: The association between time-averaged serum phosphorus concentration and all-cause mortality differs across the nutritional index. Accordingly, nutritional index should be considered when the impact of phosphorus concentration on mortality in haemodialysis patients is evaluated.


Assuntos
Avaliação Geriátrica , Avaliação Nutricional , Fósforo na Dieta/sangue , Diálise Renal/mortalidade , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/mortalidade , Causas de Morte , Feminino , Humanos , Japão , Falência Renal Crônica/sangue , Falência Renal Crônica/mortalidade , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Fósforo na Dieta/efeitos adversos , Modelos de Riscos Proporcionais , Fatores de Risco
16.
Kidney Int ; 92(6): 1384-1394, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28844316

RESUMO

Vascular calcification in chronic kidney disease is a very complex process traditionally explained in multifactorial terms. Here we sought to clarify relevance of the diverse agents acting on vascular calcification in uremic rats and distinguish between initiating and complicating factors. After 5/6 nephrectomy, rats were fed a 1.2% phosphorus diet and analyzed at different time points. The earliest changes observed in the aortic wall were noticed 11 weeks after nephrectomy: increased Wnt inhibitor Dkk1 mRNA expression and tissue non-specific alkaline phosphatase (TNAP) expression and activity. First deposits of aortic calcium were observed after 12 weeks in areas of TNAP expression. Increased mRNA expressions of Runx2, BMP2, Pit1, Pit2, HOXA10, PHOSPHO1, Fetuin-A, ANKH, OPN, Klotho, cathepsin S, MMP2, and ENPP1 were also found after TNAP changes. Increased plasma concentrations of activin A and FGF23 were observed already at 11 weeks post-nephrectomy, while plasma PTH and phosphorus only increased after 20 weeks. Plasma pyrophosphate decreased after 20 weeks, but aortic pyrophosphate was not modified, nor was the aortic expression of MGP, Msx2, several carbonic anhydrases, osteoprotegerin, parathyroid hormone receptor-1, annexins II and V, and CD39. Thus, increased TNAP and Dkk1 expression in the aorta precedes initial calcium deposition, and this increase is only preceded by elevations in circulating FGF23 and activin A. The expression of other agents involved in vascular calcification only changes at later stages of chronic kidney disease, in a complex branching pattern that requires further clarification.


Assuntos
Cálcio/metabolismo , Insuficiência Renal Crônica/patologia , Uremia/patologia , Calcificação Vascular/patologia , Fosfatase Alcalina/metabolismo , Animais , Aorta/patologia , Aorta/ultraestrutura , Biomarcadores/sangue , Modelos Animais de Doenças , Fatores de Crescimento de Fibroblastos/sangue , Humanos , Subunidades beta de Inibinas/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Masculino , Microscopia Eletrônica de Varredura , Fósforo na Dieta/efeitos adversos , Ratos , Ratos Sprague-Dawley , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/urina , Uremia/sangue , Uremia/etiologia , Uremia/urina , Calcificação Vascular/sangue , Calcificação Vascular/etiologia , Calcificação Vascular/urina
17.
Yakugaku Zasshi ; 137(7): 903-908, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28674306

RESUMO

A high dietary intake of phosphorus is considered to be a significant health threat for hemodialysis (HD) patients. Prescription medications, which might be a major source of phosphorus, is largely unrecognized in Japan. However, the amount of phosphorus indicated on the package label, is not quantified. In this study, the phosphorus content of 22 of the most widely prescribed medications that are used in conjunction with HD therapy were examined and differences between branded and generic prescription medications were compared. All samples were selected from medications that are typically prescribed for HD patients. The samples were ground prior to analysis. Phosphorus was measured using the Wako L-Type Phosphate method. All instruments used in the study were calibrated according to the manufacturers' specifications. Amlodipine (15 mg/tablet) and paroxetine (30.0 mg/tablet) were found to contain higher contents of phosphorus than the medications tested. Differences in phosphorus content between branded and generic drugs was also determined. The phosphorus content of all generic paroxetine preparations was significantly lower than the values for identical branded medications. On the other hand, the phosphorus content of several generic amlodipine preparations were significantly different from those of similar, branded preparations. Specific information regarding the phosphorus content of prescribed medications used by HD patient needs to be made available to the dialysis community.


Assuntos
Fósforo/efeitos adversos , Fósforo/análise , Medicamentos sob Prescrição/química , Diálise Renal , Anlodipino/química , Medicamentos Genéricos/química , Humanos , Japão , Paroxetina/química , Fósforo na Dieta/efeitos adversos , Fósforo na Dieta/análise
18.
Annu Rev Nutr ; 37: 321-346, 2017 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-28613982

RESUMO

Although phosphorus is an essential nutrient required for multiple physiological functions, recent research raises concerns that high phosphorus intake could have detrimental effects on health. Phosphorus is abundant in the food supply of developed countries, occurring naturally in protein-rich foods and as an additive in processed foods. High phosphorus intake can cause vascular and renal calcification, renal tubular injury, and premature death in multiple animal models. Small studies in human suggest that high phosphorus intake may result in positive phosphorus balance and correlate with renal calcification and albuminuria. Although serum phosphorus is strongly associated with cardiovascular disease, progression of kidney disease, and death, limited data exist linking high phosphorus intake directly to adverse clinical outcomes. Further prospective studies are needed to determine whether phosphorus intake is a modifiable risk factor for kidney disease.


Assuntos
Rim/fisiopatologia , Fósforo na Dieta/efeitos adversos , Insuficiência Renal Crônica/etiologia , Animais , Dieta Ocidental/efeitos adversos , Humanos , Insuficiência Renal Crônica/fisiopatologia
19.
Am J Clin Nutr ; 106(1): 311-321, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28592606

RESUMO

Background: High serum phosphorus concentrations are associated with an increased risk of cardiovascular disease and progression of chronic kidney disease (CKD). However, the relation between dietary phosphorus intake and CKD development has not been well evaluated.Objective: In this study, we investigated the impact of dietary phosphorus density on the development of incident CKD in a cohort of subjects with normal renal function.Design: Data were retrieved from the Korean Genome and Epidemiology Study, a prospective community-based cohort study. The study cohort consisted of subjects aged 40-69 y, who were followed up biennially from 2001 to 2014. A total of 873 subjects with diabetes mellitus (DM) and 5846 subjects without DM (non-DM) were included in the final analysis. The primary endpoint was incident CKD, defined as a composite of estimated glomerular filtration rate <60 mL · min-1 · 1.73 m-2 and/or the development of proteinuria.Results: In the DM and non-DM groups, the mean ages of the participants were 55.6 ± 8.7 and 51.4 ± 8.6 y, the numbers of male subjects were 454 (52.0%) and 2784 (47.6%), and the mean estimated glomerular filtration rates were 91.6 ± 14.0 and 94.5 ± 14.0 mL · min-1 · 1.73 m-2, respectively. The mean values of dietary phosphorus density, defined as the ratio of a single-day dietary phosphorus amount to the total daily calorie intake, were 0.51 ± 0.08 mg/kcal in the DM group and 0.51 ± 0.07 mg/kcal in the non-DM group. During the follow-up, CKD newly developed in 283 (32.4%) and 792 subjects (13.5%) in the DM and non-DM groups, respectively. When the subjects were divided into quartiles according to the dietary phosphorus density in each group, the highest quartile was significantly associated with the development of incident CKD by multiple Cox proportional hazard analysis in the DM group (P = 0.02) but not in the non-DM group (P = 0.72).Conclusions: High dietary phosphorus density is associated with an increased risk of CKD development in DM patients with normal renal function. The causality in this association needs to be tested in a randomized controlled trial.


Assuntos
Diabetes Mellitus , Nefropatias Diabéticas/etiologia , Ingestão de Energia , Rim/efeitos dos fármacos , Fósforo na Dieta/efeitos adversos , Fósforo/efeitos adversos , Insuficiência Renal Crônica/etiologia , Diabetes Mellitus/patologia , Dieta , Progressão da Doença , Comportamento Alimentar , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fósforo/administração & dosagem , Fósforo na Dieta/administração & dosagem , Modelos de Riscos Proporcionais , Estudos Prospectivos , Proteinúria/etiologia , Valores de Referência , Fatores de Risco
20.
Nutr Res ; 37: 58-66, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28215315

RESUMO

High dietary phosphorus (P) intake has acute negative effects on calcium (Ca) and bone metabolism, but long-term clinical data are contradictory. We hypothesized that high P intake is associated with impaired bone health as suggested by earlier short-term studies on bone metabolism. In this cross-sectional study, we investigated associations between dietary P intake, bone traits in the radius and tibia, and bone turnover in a population-based sample of 37- to 47-year-old Caucasian premenopausal women (n=333) and men (n=179) living in Southern Finland (60°N). We used various regression models in an "elaboration approach" to elucidate the role of P intake in bone traits and turnover. The addition of relevant covariates to the models mainly removed the significance of P intake as a determinant of bone traits. In the final regression model (P intake, weight, height, age, Ca intake, serum 25-hydroxyvitamin D, physical activity, smoking, contraceptive use in women), P intake was slightly positively associated only with bone mineral content and cross-sectional cortical bone area in the tibia of men. Among women, inclusion of Ca removed all existing significance in the crude models for any bone trait. In women P intake was negatively associated with the bone formation marker serum intact pro-collagen type I amino-terminal propeptide, whereas no association was present between P intake and bone turnover in men. In conclusion, these findings disagree with the hypothesis; P intake was not deleteriously associated with bone traits; however, P intake may negatively contribute to bone formation among women.


Assuntos
Densidade Óssea , Remodelação Óssea/efeitos dos fármacos , Osso e Ossos/efeitos dos fármacos , Ingestão de Energia , Grupo com Ancestrais do Continente Europeu , Osteogênese/efeitos dos fármacos , Fósforo na Dieta/farmacologia , Adulto , Osso e Ossos/metabolismo , Cálcio na Dieta/administração & dosagem , Cálcio na Dieta/farmacologia , Colágeno Tipo I/sangue , Estudos Transversais , Comportamento Alimentar , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Osteoporose , Fósforo na Dieta/efeitos adversos , Pré-Menopausa , Rádio (Anatomia)/efeitos dos fármacos , Rádio (Anatomia)/metabolismo , Fatores Sexuais , Tíbia/efeitos dos fármacos , Tíbia/metabolismo , Vitamina D/análogos & derivados , Vitamina D/sangue
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