Why is it hard for most patients to achieve target phosphate levels?
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Rania Mahmoud
Why is it hard for most patients to achieve target phosphate levels? -This may be attributed to an abundance of “hidden” phosphates in food, suboptimal adherence stemming from the burden of taking phosphate binders multiple times per day, and side effects of phosphate binders.“Hidden” phosphates in food and medications increase phosphate intake and make it more challenging to achieve phosphate control -Phosphate additives are used in many processed foods and are estimated toincrease daily phosphate intake by approximately 1000mg resulting in a total daily phosphate intake of up to approximately 2400 mg -Patients have also expressed dislike of the large size and bad taste of binders. The need to carry phosphate binders at all times may lead to stress and/or anxiety for patients and affect patients’ social interactions. -As treatment efficacy depends on proper adherence to labeled dosing instructions. Nonadherence may contribute to the inability of many patients on dialysis to achieve and maintain target phosphorus concentrations.
1-Noncompliance: due to GI side effects, burden of polypharmacy. However, ROD is progressive overtime with severe consequences, it is an initially silent disease.
2-Hidden phosphorus: “Hidden” phosphates in food and medications increase phosphate intake and make it more challenging to achieve phosphate control. Medications may be another source of hidden phosphate, as phosphate excipients are a common addition to medications prescribed to patients with CKD and can contribute an additional 100 to 200 mg of phosphate per day
3-Phosphate additives: used in many processed foods and are estimated to increase daily phosphate intake by approximately 1000 mg, resulting in a total daily phosphate intake of up to approximately 2400 mg.
4-The pill burden and S/E of phosphate binders: make ingestion difficult and unpleasant for patients. Patients have also expressed dislike of the large size and bad taste of binders.
5-limited knowledge of patients on phosphate and its effects compared with other nutrients.
6- Some dialysis providers believed that it was “less true” that phosphate binders are very important for patients on dialysis
Why is it hard for most patients to achieve target phosphate levels?This may be attributed to:
an abundance of “hidden” phosphates in food especially processed food with Phosphate additives ,
drugs increasing phosphate
suboptimal adherence due to burden of taking phosphate binders multiple times per day, and side effects of phosphate binders.
All these factors make it difficult to achieve target phosphate level
It is hard to achieve target phosphate level in most patients
the challenges are dietary phosphate intake, limited binders capacity, and poor adherence.
This may be attributed to an abundance of “hidden” phosphates in food, suboptimal adherence stemming from the burden of taking phosphate binders multiple times per day, and side effects of phosphate binders.
“Hidden” phosphates in food and medications increase phosphate intake and make it more challenging to achieve phosphate control. Phosphate additives are used in many processed foods and are estimated to increase daily phosphate intake by approximately 1000 mg,resulting in a total daily phosphate intake of up to approximately 2400 mg.These additives are “hidden” because the quantity of phosphorus they contain is not required to be listed on food labels.Medications may be another source of hidden phosphate, as phosphate excipients are a common addition to medications prescribed to patients with CKD and can contribute an additional 100 to 200 mg of phosphate per .These “hidden” phosphate sources increase phosphate load and make it difficult for patients to accurately calculate their daily phosphate intake.
It is hard for most pts to achieve target phosphate level because multi pill regimen, medication side effects, hidden phosphate in food and drugs, lack of education among pts and providers,,,
1- Hidden phosphates in food(1000mg daily) and drugs(100-200 mg daily). 2- Suboptimal adherence owing to the burden of taking phosphate binders multiple times per day . 3-side effects of phosphate binders .
4- Lack of education among patients and providers .
Challenges in Achieving Target Phosphorus Concentration:
This may be attributed to an abundance of “hidden” phosphates in food, suboptimal adherence stemming from the burden of taking phosphate binders multiple times per day, and side effects of phosphate binders.
Phosphate additives are used in many processed foods and are estimated to increase daily phosphate intake by approximately 1000 mg,46 resulting in a total daily phosphate intake of up
to approximately 2400 mg.46,47 These additives are “hidden” because the quantity of phosphorus they contain is not required to be listed on food labels
Medications may be another source of hidden phosphate, as phosphate excipients are a common addition to medications prescribed to patients with CKD and can contribute an additional 100 to 200 mg of phosphate per day
characteristics of these medications that make ingestion difficult and unpleasant for patients
patients are required to take many pills with each meal and snack
Side effects of phosphate binders, particularly those affecting the GI system, are common and may lead to treatment discontinuation
This may be due to:
1- “hidden” phosphates in food(1000mg daily) and drugs(100-200 mg daily),
2- suboptimal adherence owing to the burden of taking phosphate binders multiple times per day, and
3-side effects of phosphate binders affecting the GI system.
Phosphorus is hidden and underreported in many types of nutrients and drugs. It is present in most food additives.
The large number of pills, Gastrointestinal upset and compliance found in the majority, in addition to non-compliance and unawareness of the importance of phosphorus either by patients or health care staff (sometimes) play a role. Many patients when admitted to hospitals, have well-controlled phosphorus (diet is important)
Nice answer Dr.Mahmud. Canned and bottled drinks, Spread cheese and processed food are rich in phosphate additives, we warn the patients from having excessive amounts of these food types
It. is very difficult to the Ckd PATIENT TI REACH OPTIMAL PHOPHORE LEVEL Due to “hidden” phosphates in food, the load of taking phosphate binders numerous times a day, and adverse effects, adherence is low.
The phosphate binder method of action may make some drugs difficult and unpleasant to take. When in the GI system, binder and dietary phosphate form nonabsorbable molecules that are expelled. Binders have limited phosphate binding capacity per pill; thus patients must take numerous tablets with meals and snacks.
Why is it hard for most patients to achieve target phosphate levels?ckd and dialysis patient have reduced capacity to excrete phosphate due to kidney failure. Unfortunately loads of additives to food especially processed one have high phosphate content and even medication have phosphate as additive . Furthermore the phosphate binders are taken as multiple pills, have side effects and are not well tolerated by patients and compliance with treatment makes reaching target level of phosphate difficult
In clinical experiments, phosphate binders reduced phosphorus concentrations, however, many dialysis patients cannot reach goal concentrations. Due to “hidden” phosphates in food, the load of taking phosphate binders numerous times a day, and adverse effects, adherence is low. The phosphate binder method of action may make some drugs difficult and unpleasant to take. When in the GI system, binder and dietary phosphate form nonabsorbable molecules that are expelled. Binders have limited phosphate binding capacity per pill, thus patients must take numerous tablets with meals and snacks. Patients detest binders’ size and flavor.
Why is it hard for most patients to achieve target phosphate levels?this attributed to an abundance of hidden phosphates in food
medication may be another source of hidden phosphate
phosphate binder account for approximately 50%of total daily pill burden for patients
pt. uncompliance and taking large quantities of pills on regular basis may be unpleasant for patient .
It is hard to achieve target phosphorous because of high content of hidden phosphorous in so many food items and in food additives, non compliance of patients because of large pill size and high pill number and unpleasant taste and because of side effects of phosphate binders so lead to non compliance.
Why is it hard for most patients to achieve target phosphate levels?1-hidden phosphate in food
2-non adherence to medications (burden of taking phosphate binders multiple times per day) and side effect of phosphate binders
3-lack of education about the importance of dietary phosphate restriction
They should take more than 9 table a day and they should shew it and it doesn’t taste good and they are large in size +other side effects.
Lack of education and dietary supervision from dietician.
Hidden phosphate quantity in modern food industry.
There is decreased excretion of phosphat in urine with advanced CKD
Why is it hard for most patients to achieve target phosphate levels?
phosphate retention starts early in CKD and even adequate HD as 3 session (12 hours)/week removes only about 2/3 of the total phosphate load.
phosphate binders pills are large in size, have to be taken frequently with meals & snackes, unpalatable, have serious GIT side effects, and expensive.
low phospahate diet induces malnutrition.
phosphate content of even some drugs used in management of CKD
Nice dr Ibrahim, you can increase phosphorus removal by increasing dialysis frequency or extending its duration; with highest phosphate removal can be achieved by both mechanisms in patients maintained on nocturnal daily hemodialysis
Why is it hard for most patients to achieve target phosphate levels?
-This may be attributed to an abundance of “hidden” phosphates in food,
suboptimal adherence stemming from the burden of taking phosphate binders multiple times per day, and side effects of phosphate binders.“Hidden” phosphates in food and medications increase phosphate intake and make it more challenging to achieve phosphate control
-Phosphate additives are used in many processed foods and are estimated toincrease daily phosphate intake by approximately 1000mg resulting in a total daily phosphate intake of up to approximately 2400 mg
-Patients have also expressed dislike of the large size and bad taste of binders. The need to carry phosphate binders at all times may lead to stress and/or anxiety for patients and affect patients’ social interactions.
-As treatment efficacy depends on proper adherence to labeled dosing instructions. Nonadherence may contribute to the inability of many patients on dialysis to achieve and maintain target phosphorus concentrations.
Here is a suggested answer:
1- Noncompliance: due to GI side effects, burden of polypharmacy. However, ROD is progressive overtime with severe consequences, it is an initially silent disease.
2- Hidden phosphorus: “Hidden” phosphates in food and medications increase phosphate intake and make it more challenging to achieve phosphate control. Medications may be another source of hidden phosphate, as phosphate excipients are a common addition to medications prescribed to patients with CKD and can contribute an additional 100 to 200 mg of phosphate per day
3- Phosphate additives: used in many processed foods and are estimated to increase daily phosphate intake by approximately 1000 mg, resulting in a total daily phosphate intake of up to approximately 2400 mg.
4- The pill burden and S/E of phosphate binders: make ingestion difficult and unpleasant for patients. Patients have also expressed dislike of the large size and bad taste of binders.
5- limited knowledge of patients on phosphate and its effects compared with other nutrients.
6- Some dialysis providers believed that it was “less true” that phosphate binders are very important for patients on dialysis
Why is it hard for most patients to achieve target phosphate levels?This may be attributed to:
an abundance of “hidden” phosphates in food especially processed food with Phosphate additives ,
drugs increasing phosphate
suboptimal adherence due to burden of taking phosphate binders multiple times per day, and side effects of phosphate binders.
All these factors make it difficult to achieve target phosphate level
It is hard to achieve target phosphate level in most patients
the challenges are dietary phosphate intake, limited binders capacity, and poor adherence.
This may be attributed to an abundance of “hidden” phosphates in food, suboptimal adherence stemming from the burden of taking phosphate binders multiple times per day, and side effects of phosphate binders.
“Hidden” phosphates in food and medications increase phosphate intake and make it more challenging to achieve phosphate control. Phosphate additives are used in many processed foods and are estimated to increase daily phosphate intake by approximately 1000 mg,resulting in a total daily phosphate intake of up to approximately 2400 mg.These additives are “hidden” because the quantity of phosphorus they contain is not required to be listed on food labels.Medications may be another source of hidden phosphate, as phosphate excipients are a common addition to medications prescribed to patients with CKD and can contribute an additional 100 to 200 mg of phosphate per .These “hidden” phosphate sources increase phosphate load and make it difficult for patients to accurately calculate their daily phosphate intake.
It is hard for most pts to achieve target phosphate level because multi pill regimen, medication side effects, hidden phosphate in food and drugs, lack of education among pts and providers,,,
1- Hidden phosphates in food(1000mg daily) and drugs(100-200 mg daily).
2- Suboptimal adherence owing to the burden of taking phosphate binders multiple times per day .
3-side effects of phosphate binders .
4- Lack of education among patients and providers .
Challenges in Achieving Target Phosphorus Concentration:
This may be attributed to an abundance of “hidden” phosphates in food, suboptimal adherence stemming from the burden of taking phosphate binders multiple times per day, and side effects of phosphate binders.
Phosphate additives are used in many processed foods and are estimated to increase daily phosphate intake by approximately 1000 mg,46 resulting in a total daily phosphate intake of up
to approximately 2400 mg.46,47 These additives are “hidden” because the quantity of phosphorus they contain is not required to be listed on food labels
Medications may be another source of hidden phosphate, as phosphate excipients are a common addition to medications prescribed to patients with CKD and can contribute an additional 100 to 200 mg of phosphate per day
characteristics of these medications that make ingestion difficult and unpleasant for patients
patients are required to take many pills with each meal and snack
Side effects of phosphate binders, particularly those affecting the GI system, are common and may lead to treatment discontinuation
– hidden po4 contents in drugs and additives in preserved foods
hidden phosphates in food/medications
short sessions
non compliance
cost of some binders
unawareness
This may be due to:
1- “hidden” phosphates in food(1000mg daily) and drugs(100-200 mg daily),
2- suboptimal adherence owing to the burden of taking phosphate binders multiple times per day, and
3-side effects of phosphate binders affecting the GI system.
Hidden po4 in diet and drugs,wide distribution of po4 in diet, uncompliance with po4 chelator due to its side effects
Serum phosphorus level management challenges;
hidden phosphates in food
some medication source of hidden phosphate
in dialysis need extended sessions .
uncompliance of pts.
Phosphorus is hidden and underreported in many types of nutrients and drugs. It is present in most food additives.
The large number of pills, Gastrointestinal upset and compliance found in the majority, in addition to non-compliance and unawareness of the importance of phosphorus either by patients or health care staff (sometimes) play a role. Many patients when admitted to hospitals, have well-controlled phosphorus (diet is important)
Nice answer Dr.Mahmud. Canned and bottled drinks, Spread cheese and processed food are rich in phosphate additives, we warn the patients from having excessive amounts of these food types
It. is very difficult to the Ckd PATIENT TI REACH OPTIMAL PHOPHORE LEVEL Due to “hidden” phosphates in food, the load of taking phosphate binders numerous times a day, and adverse effects, adherence is low.
The phosphate binder method of action may make some drugs difficult and unpleasant to take. When in the GI system, binder and dietary phosphate form nonabsorbable molecules that are expelled. Binders have limited phosphate binding capacity per pill; thus patients must take numerous tablets with meals and snacks.
Why is it hard for most patients to achieve target phosphate levels?ckd and dialysis patient have reduced capacity to excrete phosphate due to kidney failure. Unfortunately loads of additives to food especially processed one have high phosphate content and even medication have phosphate as additive . Furthermore the phosphate binders are taken as multiple pills, have side effects and are not well tolerated by patients and compliance with treatment makes reaching target level of phosphate difficult
In clinical experiments, phosphate binders reduced phosphorus concentrations, however, many dialysis patients cannot reach goal concentrations. Due to “hidden” phosphates in food, the load of taking phosphate binders numerous times a day, and adverse effects, adherence is low.
The phosphate binder method of action may make some drugs difficult and unpleasant to take. When in the GI system, binder and dietary phosphate form nonabsorbable molecules that are expelled. Binders have limited phosphate binding capacity per pill, thus patients must take numerous tablets with meals and snacks. Patients detest binders’ size and flavor.
Why is it hard for most patients to achieve target phosphate levels?this attributed to an abundance of hidden phosphates in food
medication may be another source of hidden phosphate
phosphate binder account for approximately 50%of total daily pill burden for patients
pt. uncompliance and taking large quantities of pills on regular basis may be unpleasant for patient .
as you said dr Elsayed, high pill burden with lack of awareness of the importance of these pills are cornerstones for patients’ non-compliance
It is hard to achieve target phosphorous because of high content of hidden phosphorous in so many food items and in food additives, non compliance of patients because of large pill size and high pill number and unpleasant taste and because of side effects of phosphate binders so lead to non compliance.
good dr. ISRAA, sevelamer and calcium based binders are associated with the highest pill burden, while lanthnum is associated with low pill burden
Why is it hard for most patients to achieve target phosphate levels?1-hidden phosphate in food
2-non adherence to medications (burden of taking phosphate binders multiple times per day) and side effect of phosphate binders
3-lack of education about the importance of dietary phosphate restriction
They should take more than 9 table a day and they should shew it and it doesn’t taste good and they are large in size +other side effects.
Lack of education and dietary supervision from dietician.
Hidden phosphate quantity in modern food industry.
There is decreased excretion of phosphat in urine with advanced CKD
Why is it hard for most patients to achieve target phosphate levels?
Nice dr Ibrahim, you can increase phosphorus removal by increasing dialysis frequency or extending its duration; with highest phosphate removal can be achieved by both mechanisms in patients maintained on nocturnal daily hemodialysis
Why is it hard for most patients to achieve target phosphate levels?