The consistent above average home dialysis rates witnessed in New South Wales appear to be the result of renal unit culture, education strategies and policies that support ‘home dialysis first’. “
“Aim: Hyperphosphataemia is almost inevitable in end stage renal disease (ESRD) patients and is associated with increased morbidity
and mortality. In this study we examined whether oral activated charcoal (oAC) reduces serum phosphate level in haemodialysis patients. Methods: This was an open-label, prospective, uncontrolled study. One hundred and thirty-five haemodialysis patients were included in this study, with cessation of treatment with any phosphate binders during a 2 week washout period. Patients with serum phosphate levels greater than 5.5 mg/dL during the washout period were included for Gefitinib molecular weight treatment with oAC. oAC was started at a dose of 600 mg three times per day with meals and was administered for 24 weeks. oAC dose was titrated up during the 24 week period to achieve phosphate control (3.5–5.5 mg/dL). A second 2 week washout period followed the end of oAC treatment. Results: In the 114 patients who successfully completed the trial, the mean dose of activated charcoal was PI3K inhibitor 3190 ± 806 mg/day. oAC reduced
mean phosphate levels to below 5.5 mg/dL, with mean decreases of 2.60 ± 0.11 mg/dL (P < 0.01) and 103 (90.4%) of the patients reached the phosphate target. After the second washout period the phosphate levels increased to 7.50 ± 1.03 mg/dL (P < 0.01). Serum intact parathyroid hormone (iPTH) levels declined from 338.75 ± 147.77 pg/mL to 276.51 ± 127.82 pg/mL (P < 0.05) during the study. oAC had 5-FU cost no influence on
serum prealbumin, total cholesterol, triglycerides, serum ferritin, haemoglobin or platelet levels and the levels of 1,25-dihydroxyvitamin D were stable during the study. Conclusion: In this open-label uncontrolled study, oAC effectively controls hyperphosphataemia and hyperparathyroidism in haemodialysis patients. The safety and efficacy of oAC needs to be assessed in a randomized controlled trial. “
“Currently available calcium and aluminium based phosphate binders are dose limited because of potential toxicity, and newer proprietary phosphate binders are expensive. We examined phosphate-binding effects of the bile acid sequestrant colestipol, a non-proprietary drug that is in the same class as sevelamer. The trial was an 8-week prospective feasibility study in stable hemodialysis patients, using colestipol as the only phosphate binder, preceded and followed by a washout phase of all other phosphate binders. The primary study endpoint was weekly measurements of serum phosphate. Secondary endpoints were serum calcium, lipids, and coagulation status. Analyses used random effects mixed models. 30 patients were screened for participation of which 26 met criteria for treatment. At a mean dose of 8.8g/24h of colestipol by study end, serum phosphate dropped from 2.24mmol/L to 1.