E-learning modules for Integrated Virtual Learning


    Medications in Hemodialysis

    Share

    nancelle
    Guest

    Medications in Hemodialysis

    Post  nancelle on Wed 24 Jun 2009, 12:02 am

    Posted by : Nancelle Dumlao/Rodel Perez

    Colestimide can be used as a phosphate binder to treat uraemia in end-stage renal disease patients

    Individuals with end-stage renal disease (ESRD) who are undergoing dialysis may develop complications such as secondary hyperthyroidism which could result to the increase in the phosphate level in the body. Since phosphate cannot be readily removed through dialysis, there is a need to control the phosphate level either by limiting intake of phosphate-rich foods or utilizing phosphate binders such as aluminum or calcium compounds. However, recent studies have shown that these phosphate binders have deleterious effects such as encephalopathy and hypercalcemia (causing bone disease), respectively. Fortunately, Colestimide , a new drug which is actually a potent substance used to treat hypercholesterolemia, has been accidentally discovered to lower the serum phosphate level of one patient. This study was undertaken to ascertain the effectivity of using Colestimide in reducing the serum phosphate level of ESRD patients undergoing hemodialysis. The study enrolled 28 subjects having no hypercalcemia but suffers from hyperphosphataemia (4.0mg/dl) and being treated with 3.5±1.1 g/day calcium carbonate. All subjects have three haemodialysis sessions per week using 2.5 mEq/l Ca dialysate to treat uremia. These conditions were not changed during the study. To validate the therapeutic effect of colestimide, each patient were given the drug with a dosage of 3.0g/day before every meal for 4 weeks. Bi-monthly monitoring of serum phosphate and other pertinent serum substances (e.g. calcium, PTH, cholesterol and uric acid) were done and adjustments to the dosage (1.5 g/day) was done if necessary (e.g. constipation and /or meteorism). The subjects’ age was 54.3±12.4 years (mean±SD), and the dialysis period was from 9.6±6.8 years (mean±SD). The mean±SD are used for all data. Also, the analysis of covariance (ANOVA) with multiple comparisons were utilized to facilitate statistical analysis. The significance level was set at 5%.


    The result of the study indicated that colestimide also has therapeutic value in terms of treating hyperphosphataemia for these patients who are undergoing hemodialysis. Aside from lowering the serum phosphate level, the new phosphate binder also did not cause hypercalcemia or
    did not increase the risk for vascular calcification (high CaXPi) unlike the previous calcium treatments.
    However, adverse effects such as gastrointestinal symptoms (constipation or meteorism) were also detected during the clinical trial. Moreover, the therapeutic effect of the calcium-free and aluminum-free colestimide occurs early ( in 2 weeks time and improved in 4 weeks time) and it can be used together with calcium carbonate.


    This study is very valuable for ESRD patients who have been undergoing hemodialysis for several years because the new drug, colestimide, prevents complications of ESRD such as hyperphosphataemia and therefore, lengthens the survival period of these individuals. It is a known fact that ESRD patients encounter many difficulties while taking the renal replacements therapies for the remaining years of their lives -- more important than the financial burden, these patients experience emotional and psychological hardships due to the effect of the procedure in the quality of their lives and the constant fear of probable complications that could develop as a result of the long-term hemodialysis. Everytime a new drug that could decrease the risk of complications of ESRD is discovered, the patients as well as their loved ones are given new hope to have longer and happier lives.

    Reference:

    Toshiyuki Date, Takashi Shigematsu, Yoshiteru Kawashita, Nobuyoshi Satake and Kyoko Morita. Colestimide Can Be Used as a Phosphate Binder to Treat Uraemia in End-stage Renal Disease Patients. Nephrology Dialysis Transplantation. 2003. 18: III90-III93.

    Jinaikai Date Clinic and Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University of Medicine, Tokyo, Japan.

      Current date/time is Thu 20 Sep 2018, 3:07 am