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Exact(5)
This may lead to an increased need for phosphate binders, vitamin D and calcimimetics with a higher PB.
Amongst these are the limitations of dietary phosphate restriction, giving rise to the need for phosphate binder therapy to maintain serum phosphate control.
However, there is some recent evidence that quotidian (i.e. short daily dialysis) is more effective than conventional hemodialysis in reducing serum phosphate and the need for phosphate binders (Achinger & Ayus 2005).
The use of a phosphate-containing CRRT solution, accounting for about 50 to 60% of the CRRT dose in the setting of RCA-CVVH or RCA-CVVHDF, allowed one to prevent CRRT-induced phosphate depletion in most of the patients, minimizing the need for phosphate supplementation and maintaining phosphorus levels in a near-normal range throughout CRRT days.
Starting from September 2011, in order to optimize buffer balance and to reduce the need for phosphate supplementation, a new RCA-CVVH protocol has been designed using an 18 mmol/l citrate solution combined with a recently introduced phosphate-containing replacement fluid with bicarbonate (HCO3- 30, phosphate 1.2, Ca2+ 1.25, Mg2+ 0.6, K+ 4 mmol/l) (protocol B).
Similar(54)
The calcitriol remained elevated after 6 months, when PTH and FGF23 were in reference range, reflecting an intrinsic regulation of calcitriol production stimulated by a positive phosphate balance due to continuing mineralization of the skeleton and need for increased phosphate reabsorption to maintain homeostasis.
Today, there is a trend toward the use of larger and faster boluses of phosphate because of high failure of repletion (20 70%) and the need for additional phosphate administration.
Agreement exits regarding the need for dietary phosphate control, but it is quite challenging in the real-life setting.
The need for high phosphate concentrations in the phloem may be related to ATP-dependent phloem unloading.
There is a need for new phosphate binders that address the limitations of current treatments and enable patients to achieve and maintain adequate control of serum phosphate levels.
These increases may reflect the need for increased phosphate buffering and preservation of ATP associated with the increased cardiac output of 40-50% during pregnancy [ 31, 32].
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