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Reduction of hyperphosphatemia is related with the reduction of C-reactive protein in dialysis patients. Study in sevelamer-resistant dialysis patients treated with chitosan chewing gum as salivary phosphate binder.
Ren Fail. 2011; 33(1):11-4.RF

Abstract

BACKGROUND

In end-stage renal disease (ESRD) hyperphosphatemia associates with vascular calcifications and cardiovascular events derived from endothelial dysfunction. In dialysis patients, C-reactive protein (CRP), a marker of inflammation, associates with cardiovascular mortality. Increased PO(4) concentration impairs endothelial integrity via induction of oxidative stress, and sevelamer, a phosphate binder, showed anti-inflammatory effect reducing CRP, which paralleled PO(4) reduction. To give support to a direct proinflammatory role of hyperphosphatemia "per se," we have considered previously studied dialysis patients with sevelamer-"resistant" hyperphosphatemia, who were treated with a chitosan-loaded chewing gum, as salivary phosphate binder, in addition to sevelamer, reduced serum PO(4) to normal, to retrospectively evaluate their CRP and the relationship with hyperphosphatemia and calcium × phosphate (Ca × PO(4)) product.

PATIENTS AND METHODS

High sensitive (hs) CRP of 13 previously studied hemodialysis patients with sevelamer-resistant hyperphosphatemia was evaluated with immunonephelometry.

RESULTS

Chitosan chewing gum use reduced hsCRP (from 1.38 ± 0.61 to 0.39 ± 0.16 mg/L after the gum, p < 0.0002), which returned to baseline after 4 weeks from gum discontinuation (1.25 ± 0.41). hsCRP reduction paralleled serum PO(4) reduction: from 7.60 ± 0.91 mg/dL to 5.18 ± 0.73 (after the gum) (p < 0.00001), returning to baseline (7.55 ± 0.75) after gum discontinuation. hsCRP reduction directly correlated with PO(4) reduction (p = 0.029).

CONCLUSION

The relationship in sevelamer-resistant dialysis patients between the reduction of serum PO(4), induced by the chitosan-loaded chewing gum, and CRP reduction supports also in humans a proinflammatory role of hyperphosphatemia "per se" derived from "in vitro" studies. This further contributes to the high cardiovascular risk of ESRD patients making their serum phosphate in the normal range of vital importance.

Authors+Show Affiliations

Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy. renzcalo@unipd.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21219199

Citation

Calò, Lorenzo A., et al. "Reduction of Hyperphosphatemia Is Related With the Reduction of C-reactive Protein in Dialysis Patients. Study in Sevelamer-resistant Dialysis Patients Treated With Chitosan Chewing Gum as Salivary Phosphate Binder." Renal Failure, vol. 33, no. 1, 2011, pp. 11-4.
Calò LA, Savica V, Piccoli A, et al. Reduction of hyperphosphatemia is related with the reduction of C-reactive protein in dialysis patients. Study in sevelamer-resistant dialysis patients treated with chitosan chewing gum as salivary phosphate binder. Ren Fail. 2011;33(1):11-4.
Calò, L. A., Savica, V., Piccoli, A., Fusaro, M., D'Angelo, A., & Davis, P. A. (2011). Reduction of hyperphosphatemia is related with the reduction of C-reactive protein in dialysis patients. Study in sevelamer-resistant dialysis patients treated with chitosan chewing gum as salivary phosphate binder. Renal Failure, 33(1), 11-4. https://doi.org/10.3109/0886022X.2010.528116
Calò LA, et al. Reduction of Hyperphosphatemia Is Related With the Reduction of C-reactive Protein in Dialysis Patients. Study in Sevelamer-resistant Dialysis Patients Treated With Chitosan Chewing Gum as Salivary Phosphate Binder. Ren Fail. 2011;33(1):11-4. PubMed PMID: 21219199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduction of hyperphosphatemia is related with the reduction of C-reactive protein in dialysis patients. Study in sevelamer-resistant dialysis patients treated with chitosan chewing gum as salivary phosphate binder. AU - Calò,Lorenzo A, AU - Savica,Vincenzo, AU - Piccoli,Antonio, AU - Fusaro,Maria, AU - D'Angelo,Angela, AU - Davis,Paul A, PY - 2011/1/12/entrez PY - 2011/1/12/pubmed PY - 2011/6/7/medline SP - 11 EP - 4 JF - Renal failure JO - Ren Fail VL - 33 IS - 1 N2 - BACKGROUND: In end-stage renal disease (ESRD) hyperphosphatemia associates with vascular calcifications and cardiovascular events derived from endothelial dysfunction. In dialysis patients, C-reactive protein (CRP), a marker of inflammation, associates with cardiovascular mortality. Increased PO(4) concentration impairs endothelial integrity via induction of oxidative stress, and sevelamer, a phosphate binder, showed anti-inflammatory effect reducing CRP, which paralleled PO(4) reduction. To give support to a direct proinflammatory role of hyperphosphatemia "per se," we have considered previously studied dialysis patients with sevelamer-"resistant" hyperphosphatemia, who were treated with a chitosan-loaded chewing gum, as salivary phosphate binder, in addition to sevelamer, reduced serum PO(4) to normal, to retrospectively evaluate their CRP and the relationship with hyperphosphatemia and calcium × phosphate (Ca × PO(4)) product. PATIENTS AND METHODS: High sensitive (hs) CRP of 13 previously studied hemodialysis patients with sevelamer-resistant hyperphosphatemia was evaluated with immunonephelometry. RESULTS: Chitosan chewing gum use reduced hsCRP (from 1.38 ± 0.61 to 0.39 ± 0.16 mg/L after the gum, p < 0.0002), which returned to baseline after 4 weeks from gum discontinuation (1.25 ± 0.41). hsCRP reduction paralleled serum PO(4) reduction: from 7.60 ± 0.91 mg/dL to 5.18 ± 0.73 (after the gum) (p < 0.00001), returning to baseline (7.55 ± 0.75) after gum discontinuation. hsCRP reduction directly correlated with PO(4) reduction (p = 0.029). CONCLUSION: The relationship in sevelamer-resistant dialysis patients between the reduction of serum PO(4), induced by the chitosan-loaded chewing gum, and CRP reduction supports also in humans a proinflammatory role of hyperphosphatemia "per se" derived from "in vitro" studies. This further contributes to the high cardiovascular risk of ESRD patients making their serum phosphate in the normal range of vital importance. SN - 1525-6049 UR - https://www.unboundmedicine.com/medline/citation/21219199/Reduction_of_hyperphosphatemia_is_related_with_the_reduction_of_C_reactive_protein_in_dialysis_patients__Study_in_sevelamer_resistant_dialysis_patients_treated_with_chitosan_chewing_gum_as_salivary_phosphate_binder_ L2 - https://www.tandfonline.com/doi/full/10.3109/0886022X.2010.528116 DB - PRIME DP - Unbound Medicine ER -