Restriction and PB Therapy

From a general viewpoint, it can be stated that it should always be possible to reduce intestinal iP absorption to a level which can be balanced by dialysis phosphorus elimination. That neutral phosphorus balance can be achieved with the combined efforts of today's treatment options has been demonstrated by various studies on the efficacy of PBs. In the treat-to-goal study normophosphatemia was achieved within a couple of weeks after study initiation [24]. The 'secret' of this success lies in repeated and intensive patient counseling and stepwise adjustments of PB dosage to serum phosphate levels. In the treat-to-goal study sevelamer-treated subjects ingested an average of 8 tablets (800 mg), while calcium acetate-treated subjects ingested an average dose of seven tablets (667 mg)/day. In both study groups normalization of phosphate levels (5.1 8 1.2 and 5.1 8 1.4 mg/dl, respectively) was achieved. The more intense patient care in a study setting may also have contributed to the successful lowering of phosphate levels.

In order to adequately lower intestinal phosphorus absorption, PB dose ideally should be adjusted to the meal phosphorus content on a meal-to-meal basis, similar to adjusting the insulin dose to a meal carbohydrate content in the treatment of diabetes. A new concept (Phosphate Education Program, PEP) has recently been developed which allows patients to self-adjust the PB dose to the phosphorus content of each individual meal. This can only be successfully achieved when assessment of the phosphorus content of a meal is quick and simple without involving multi-page food tables, booklets or even computers. The innovative concept is based on the introduction of the phosphorus unit (PU) which indicates the food phosphorous content, with 1 PU assigned per 100 mg of phosphorous per serving size. Since food components be longing to the same food group (e.g. meat, sea food, vegetables, etc.) tend to have similar phosphorus content, just one PU value can be assigned to whole food groups. For example, any fish filet (serving size 150 g) = 4 PU, and any meat (serving size 150 g) = 3 PU.

The new concept bears the advantage that patients do not have to memorize the phosphorus content of each individual food component, but only the PU value for a limited number of food groups. After eye-estimating the PU content of a meal, the patient self-adjusts the PB dose according to a PB/PU ratio prescribed by the nephrolo-gist. After introducing the PEP concept to the patient, the PB/PU ratio is titrated to the patient's individual needs by repeatedly measuring predialysis serum phosphate levels and re-adjusting the PB/PU ratio until phosphate targets have been achieved. This new concept moves away from strict dietary phosphorus restriction towards a more adequate dosing of PBs. It allows patients to maintain an adequate dietary protein intake with a more liberal diet while at the same time reducing the risk of developing hyperphosphatemia. Diet-related hyperphosphatemia can be prevented by adequate PB dosing. PEP (www.pep-ernaehrungsprogramm.de) is the first approach applying the concept of patient empowerment in the management of hyperphosphatemia in dialysis patients.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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