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Calcium and phosphorus metabolism in patients who have chronic kidney disease.

Disturbances in calcium and phosphorus metabolism are almost invariable consequences of chronic kidney disease (CKD). Because the capacity to regulate calcium and phosphorus metabolism becomes compromised progressively as kidney function declines, calcium and phosphorus homeostasis is disrupted and serum calcium or phosphorus levels are perturbed in many patients with CKD. The level of interest in, and concerns about, abnormalities in calcium and phosphorus metabolism among patients with CKD has increased substantially in recent years. Strategies for clinical management are being revised, and recent recommendations differ substantially from those used previously with a renewed emphasis on safety.

Calcium↗

[Changes of control of disorders of calcium and phosphorus metabolism in Lithuanian hemodialysis centers 1996-2003].

The aim of the study was to evaluate the changes of the rate of disorders of calcium and phosphorus metabolism and their control in patients on hemodialysis (HD) in Lithuania in 1996-2003. Every December during this period we visited all HD centers of Lithuania and collected data on calcium-phosphorus metabolism in HD patients. 51.8% of HD patients in 1999 and 44.6% in 2003 had hyperphosphatemia (>1.8 mmol/l) (p<0.05). The mean phosphate concentration was 1.82+/-0.56 mmol/l in 2003 (p<0.05, comparing with 1.95+/-0.72 mmol/l in 1999 and 1.9+/-0.72 mmol/l in 2001). 7.1% of HD patients had hypocalcemia in 2003 and 7.8% hypercalcemia. Serum parathyroid hormone level was investigated only in 27.3% of HD patients in 1999 and 84.8% in 2003 (p<0.05). Use of alfacalcidol significantly decreased from 77.5% in 1998 to 29.4% in 2003, when the evaluation of serum parathyroid hormone increased (r=-0.911, p=0.03). Serum parathyroid hormone level was not analyzed for 59.8% of patients who used alfacalcidol and 59.4% of them had hyperphosphatemia in 1999 (6.3% and 32.9% in 2003, respectively; p<0.05). 10.7% of these patients had hypercalcemia in 2003. In summary, the correction of disorders of calcium and phosphorus metabolism in HD patients was insufficient but ameliorative. Monitoring of serum parathyroid hormone increased significantly during 1997-2003. The percentage of the precarious use of alfacalcidol decreased significantly when the evaluation of serum parathyroid hormone level became regular.

Calcium↗

[Effect of long-term administration of thyroxine on the content of nucleic acids and certain indicators of phosphorus metabolism in the liver in experimental thyrotoxicosis].

In the liver of albino rats with experimental thyrotoxicosis a study was made of nucleic acids and some indices of phosphorus metabolism: total and inorganic phosphorus, total and acid-soluble phosphorus, phosphorus of RNA, DNA and phosphoproteins. A significant elevation of the RNA and DNA content was noted 1 1/2 months from the beginning of the experiment. An increase of the concentration of nucleic acid phosphorus and a simultaneous reduction of the content of phosphorus of phosphoproteins and inorganic phosphorus was noted in the phosphorus metabolism indices under study. The content of total and acid-soluble phosphorus displayed no significant change. The data obtained indicated that, along with increased catabolism in thyrotoxicosis there occurred rather intensive synthesis, without reaching the normal level, however.

Animals↗

Effects of sleep deprivation: the phosphorus metabolism in the human brain measured by 31P-magnetic resonance spectroscopy.

Sleep deprivation (SD) has an antidepressant effect in some, but not all, patients with depression, although its biological mechanisms have not yet been characterized. We previously reported altered brain phosphorus metabolism measured by phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in patients with bipolar depression. We preliminarily examined effects of SD on phosphorus metabolism in the frontal lobes of 15 normal subjects using 31P-MRS. No significant differences of membrane phospholipid metabolism, high-energy phosphate metabolism and intracellular pH were found between before and after SD in these subjects. Further studies will be necessary to elucidate the physiological mechanism of SD for depressive patients.

Adolescent↗

Influence of dietary phosphorus restriction on calcium and phosphorus metabolism in rats.

The effect of dietary phosphorus (P) on calcium (Ca) and phosphorus metabolism was studied in young female rats. P levels in the semipurified diets ranged from 0.1 to 0.4% (w/w). A level of 0.4% P in the diet is recommended for rats. Kidney calcification was observed in rats fed the 0.4%-P diet whereas P restriction prevented this condition. Rats fed the diet containing 0.1% P, showed severe hypercalciuria, hypercalcemia, reduced growth and impaired bone mineralization. These effects did not occur when the diet contained 0.2 or 0.3% of P. This study suggests that in short-term studies P in the diet of female rats can be restricted to 0.2% so as to prevent nephrocalcinosis without affecting their development.

Animals↗

Multiple regression analysis of relationship between frontal lobe phosphorus metabolism and clinical symptoms in patients with schizophrenia.

We investigated the differences among diagnostic types of 36 schizophrenic patients in the brain phosphorus metabolism in the frontal lobe. We performed phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in the frontal region in patients with schizophrenia of the catatonic (n = 4), disorganized (n = 8), paranoid (n = 10) and undifferentiated (n = 14) types. In the disorganized type, the PME level was significantly decreased compared to those in the other three types, while the phosphodiester (PDE) level tended to be higher, although not significantly, than those in the other types. Using multiple regression analysis, we investigated whether or not the clinical symptoms were correlated with the brain phosphorus metabolism. An increased motor retardation factor score was significantly correlated with decreased PME level, whereas more severe emotional withdrawal and blunted affect were associated with increased PDE level. These results suggest that altered membrane phospholipid metabolism in the frontal region may be associated with negative symptoms and that schizophrenia of the disorganized type is associated with more severe negative symptoms and may present more severe brain abnormalities compared to the other types.

Adolescent↗

Effect of calcium on phosphorus metabolism in man.

The effect of calcium on phosphorus metabolism was studied in adult males by determining phosphorus and calcium balances during three calcium intakes of approximately 200, 800, and 2000 mg/day. Each of these calcium intakes were given during two intake levels of phosphorus of approximately 800 and 2000 mg/day. In all studies, the addition of different amounts of calcium led to a significant decrease of the urinary phosphorus, a significant increase of the stool phosphorus, and significant improvement of the phosphorus balance irrespective of the phosphorus intake. Only in one study in which the calcium intake was increased from 230 to 831 mg/day during the high phosphorus intake of approximately 2000 mg/day were these changes not significant. During all calcium intakes, the decrease in urinary phosphorus was greater than the increase in stool phosphorus irrespective of the phosphorus intake. The apparent absorption of phosphorus decreased on increasing the calcium intake. The calcium balance was not adversely affected by increasing the phosphorus intake to 2000 mg/day during any of the calcium intakes.

Adult↗

Long-term animal feeding trial of the refined konjac meal. I. Effects of the refined konjac meal on the calcium and phosphorus metabolism and the bone in rat.

Effects of refined konjac meal (RKM) on the calcium and phosphorus metabolism and bone parameters were observed in rats of both sexes fed with food containing 1% of RKM for 18 months. A comparable group of rats fed on basic diet only was used as a control. Results obtained indicate that all the measured parameters (serum calcium and phosphorus level, femur weight and its calcium and phosphorus content, and the osteometry of the tibia) showed no significant difference between the experimental and the control groups. Thus there is no adverse effect either on the calcium and phosphorus metabolism or on the bone after a long-term intake at a moderate dosage.

Animals↗