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      Long-Term Control of Hyperparathyroidism in Advanced Renal Failure by Low-Phosphorus Low-Protein Diet Supplemented with Calcium (without Changes in Plasma Calcitriol)

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          Abstract

          Phosphorus (Pi) retention linked to chronic renal failure (CRF) favors secondary hyperparathyroidism (HPT). Reduction of Pi and protein intake has been shown to prevent the development of HPT in CRF. The aim of the present study was to assess in patients with advanced CRF the long-term effects on phosphate and calcium metabolism of a low-Pi (5-7 mg/kg/day), low-protein (0.4 g/kg/day) diet providing 300 mg/day calcium (Ca) and supplemented with amino acids and ketoacids, Ca carbonate (400-800 mg/day) and vitamin D<sub>2</sub> (1,000 IU/day). Twenty-nine patients with advanced CRF (glomerular filtration rate (GFR) 13.7 ± 4.5 ml/min) were selected for the study, on the basis of a follow-up of a least 2 years and a satisfactory compliance to the prescribed diet. At the start of the study, biological evidence of HPT was present with increased plasma PTH concentration (144 ± 95 pg/ml), increased plasma Pi (1.57 ± 0.33 mmol/l), an increase in alkaline phosphatase activity and plasma osteocalcin concentration. Plasma PTH concentration was positively correlated with plasma Pi and inversely with plasma Ca concentrations and GFR. Pi and protein restriction induced a significant correction of HPT within 3 months after starting the diet. After 2 years of diet, despite the diminution of GFR (11.1 ± 3.7 ml/min, p < 0.0001), plasma PTH was still lower than at the start of the diet (88 ± 57 pg/ml, p < 0.01), as was plasma Pi (1.32 ± 0.24 mmol/l, p < 0.001), total plasma Ca being higher (p < 0.01). Plasma PTH levels were correlated only to plasma Ca concentrations. However, variations in plasma PTH concentrations were correlated with changes in plasma Ca and Pi concentrations, but not with changes in GFR. Plasma calcitriol concentrations (measured in 14 patients) did not increase significantly. The results of the present study suggest that Pi and protein restriction with calcium supplementation and without calcitriol supplementation in patients with advanced CRF may induce a lasting correction of HPT, potentially mediated by the reduction of plasma Pi and the increase of plasma Ca concentrations, independently of plasma calcitriol.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1995
          1995
          18 December 2008
          : 70
          : 3
          : 287-295
          Affiliations
          Services de Néphrologie aHôpital Pellegrin, Bordeaux, bHôpital Universitaire d’Amiens, France
          Article
          188606 Nephron 1995;70:287–295
          10.1159/000188606
          7477615
          © 1995 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 9
          Categories
          Original Paper

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