Other Emerging Phosphate Binders for Kidney Dialysis Patients

Over the past five years, there are more new generations of phosphate binders for kidney dialysis patients. Some of them are very costly (e.g. Sevelamer and lanthanum carbonate) though effective. There have also been a lot of side-effects associated with these drug intake. For example, nausea and vomiting are pretty common with taking Renagel (sevelamer HCl / carbonate)

Here are some information of the new emerging phosphate binders, in addition to niacin / nicotinamide that this blog has discussed earlier.

However, one has to be cautious in taking these new P-binders. Have to talk to your healthcare providers and monitor your health conditions constantly. For example, taking magnesium-containing binders can render patients more prone to develop hypermagnesium which can lead to defect on electrolyte balance, neuromuscular toxicity etc.

 Latest P-binders:

http://www.healtheconomicsreview.com/content/pdf/2191-1991-1-1.pdf

1. Combination drug of Calcium acetate / Magensium carbonate - Osvaren

http://www.scottishmedicines.org.uk/files/advice/calcium_acetate_and_magnesium_carbonate_Osvaren_FINAL_MARCH_2011_for_website.pdf

http://www.fmc-ag.com/3179.htm

http://ndt.oxfordjournals.org/content/25/11/3707.full.pdf+html

http://www.fmc-renalpharma.com/osvaren.htm

http://www.cvz.nl/binaries/content/documents/cvzinternet/en/documents/assessments/asm1004-calcium-acetate-magnesium-carbonate-osvaren.pdf

http://www.cvz.nl/binaries/content/documents/cvzinternet/en/documents/assessments/asm1004-calcium-acetate-magnesium-carbonate-osvaren.pdf

Note: a cheaper generic version of Phoslo may be available commercially as Calphron from Nephro-Tech. The company also offers Magensbind (magnesium carbonate / calcium carbonate) at both prescription and over-the-counter versions.

http://www.nephrotech.com/order%20information.htm

2. Iron-Magnesium Hydroxycarbonate (Fermagate):

http://cjasn.asnjournals.org/content/4/2/401.full.pdf

  

3. Chitosan-loaded chewing gum

http://jasn.asnjournals.org/content/20/3/639.full.pdf+html

On this, Nestle has acquired CM&D Pharma for making chitosan chewing gums as one of its medical food lead targets.

 http://www.nutraceuticalsworld.com/issues/2011-06/view_editorials/nestle-has-seen-the-light-mdash-have-you-/

http://www.nestlehealthscience.com/SiteCollectionDocuments/Documents/Newsroom%20Documents/2011/FactSheet-Chronic-kidney-disease-hyperphosphataemia-and-its-management.pdf

http://cnfolio.com/media/wsj_nestle_buys_medical_startup.pdf

Dietary Supplements as Stem Cells Enhancers / Activators

Here is some literature information on using dietary supplement to boost adult stem cells to help on kidney health. Basically, it is using some stem cell enhancers / activators, kidney-targeted growth factors (e.g. insulin growth factor) or others to help on nascent nephron growth or differentiation in vivo or in vitro.

One hypothesis is to enhance stem cells from our body (from bone marrows per se) and stimulate it to migrate towards the organs of interest (e.g. kidney) and differentiate there to functional tissues (such as nephrons).

Some such supplements include:

1. cordyceps sinemis  (冬蟲夏草)to increase adult stem cells in your bone marrow

2. velvet antler -(鹿茸) to provide growth factors (insulin growth factor, epidermal growth factor) for the growth and differentiation of stem cells)

3. NutraStem Sport - proprietary blend commercially available from Natura Therapeutics

 and others

Ref:

http://newstemcells.stemtechbiz.com/StemEnhance.aspx
http://www.naturatherapeutics.com/nutrastem
http://www.stem-kine.com/
http://www.jleukbio.org/content/85/6/987.full.pdf
http://www.cyut.edu.tw/~ijase/2005/IJASE%20-%203-3-6.pdf

cordyceps reference:

www.cyut.edu.tw/~ijase/2005/IJASE%20-%203-3-6.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775070/pdf/nihms96160.pdf

velvet antler reference:

http://onlinelibrary.wiley.com/doi/10.1002/dvdy.20742/pdf

http://www.antisteroidprogram.com/eDocs/velvet_antler_paper.pdf

www.xfcjwkzazhi.cn/OA/pdfdow.aspx?Type=pdf&FileName...pdf

Adult stem cell activation:

using NutraStem (blueberry/carnosine/green tea/Vitamin D3)

http://www.naturatherapeutics.com/images/Scientific_Article_1.pdf

 http://www.naturatherapeutics.com/images/Scientific_Article_3.pdf

 using blue-green algae (AFA) :

http://www.biomedcentral.com/content/pdf/1479-5876-8-34.pdf

http://www.simplexityhealth.com/resources/pdf/blue-green_algae_extracts.pdf

http://www.microwaterman.com/StemEnhance/StudySummaryV4.pdf

(Although AFA can have action of mobilize stem cells, there is concern on toxcity in some contaminants growing in the source - microcystin. Even though batch of AFA may have undergo QC check, it'd be better not to run the risk of eating tainted AFA extract. So, I think nutrastem is a better alternative to AFA at this stag , as stem cell activator )

other supplements:

http://www.ansci.wsu.edu/personal/homepage/dodson/Dodson%20Publications/Research%20Publications/Paper%20%23105%202010%20IJSC%20Fernyhough.pdf

Stem Cell Therapy for Kidney Regeneration

Hi,

It’s been a long while since my last posting. Here is something on stem cell therapy. There has been hope on using stem cell for kidney regeneration.

Some doctors are found to treat patients with stem cell.
Be careful when you select to try stem cell therapy as this is still in early experimental stage and not approved or regulated in a lot of countries. There have also been fatalities associated with malpractice of stem cell treatment.

http://www.asn-online.org/press/files/Quaggin_editorial.pdf

However, the use of stem cells is still very promising and has posed for different angles of using it. This will be discussed in the next posting – Stem Cell Enhancers / Activators.

Other references:

http://ajpregu.physiology.org/content/276/4/R929.full.pdf+html

http://www.asn-online.org/press/files/Quaggin_editorial.pdf

http://www.medicalnewstoday.com/articles/192148.php

http://www.pnas.org/content/early/2010/02/12/0912228107.full.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649608/pdf/org0301_0034.pdf
http://docsdrive.com/pdfs/ansinet/jbs/2010/705-717.pdf

Kidney regeneration by stem cell approach:

http://docsdrive.com/pdfs/ansinet/jbs/2010/705-717.pdf

http://downloads.sage-hindawi.com/journals/ijn/2011/591731.pdf

http://www.pnas.org/content/early/2010/02/12/0912228107.full.pdf

http://www.sld.cu/galerias/pdf/sitios/medregenerativa/kidney_regeneration.pdf

Dietary watch after stem cell therapy:

http://www.dana-farber.org/pat/support/nutrition/docs/nutritional-guidelines-after-stem-cell-transplant.pdf

http://pfrc.med.nyu.edu/handouts/pdf/all/pfrc07-000004.pdf

Coenzyme Q10 (Q-Gel), Niacin-extended release and Probiotics on renal dialysis

Hi,

 My friend on hemodialysis has tried some dietary supplements and gave feedback to me they have helped in his situations. I am not here to endorse any of these. Just thought to share his observation. ..

  1. After 3-4 months of trying niacin extended -release tablets, (immediate release may not work as it is not tested ) his phosphorus level is now controlled in normal level, and that is also with Renagel.  Before that, even with Renagel, his P is getting way high and skin itching  and other sideeffects show up.

  2. he also noticed some help with Q-gel ( bioavailable formulation of Coenzyme Q10), seems to make his heart stronger by withstanding some sideeffects of dialysis, such as nausea or vomiting. 

  3. For Probiotics, after a few days of trying, he noticed he can excrete faeces more smoothly and that's a big help to him.


   anyway, pls do talk with your healhcare provider before taking in any dietary suppplements. While they may work from soome people, they may trun to be bad for others. Be vigilent about what we take in.

  happy health!

Astaxanthin - potential super antioxidant?

Hi,

    Astaxanthin has showed up in literature as a super antioxidant, 100-500 times the antioxidant capacity of Vitamin E and 10 times the antioxidant capacity of beta-carotene. It is present in some birds and salmon, being highest in sockeye salmon. Some literature data suggests  its beneficial role in combating against acute renal toxicity in HgCls-fed aminal rat. Several clinical trials are ongoing in renal transplant subjects on testing cardiac advantanges., as well as on hemodialysis patients

  There may be some potential of taking astaxanthin to help body through the reduction of cardiac overload, removal of reactive oxygen species (ROS) to attain longer vessel dilation, improvement of  HDL/cholesteral ratio and  modulation of immune system etc.

    Astaxanthin can cross blood-brain barrier and it can populate in CNS and retinal membranes. Its use in eye health has been promising. However, long term safety studies on the use of astaxanthin in human trials is not yet available. Its use in kideny patients is also not reported yet, despites some positive thinking.

----
Ref: 
http://www.biomedcentral.com/content/pdf/1471-2369-9-17.pdf
http://www.ruscom.com/cyan/web02/pdfs/bioastin/batl09.pdf
http://www.cyanotech.com/pdfs/bioastin/axbul62.PDF

Probiotics and uremia (益生菌和尿毒症)

Hi,

Uremia is one unwanted complication that may happen in patients of endstage renal diseases (ESRD). For the past several decades, different approaches have been adopted to tackle it. A few are based on the use of enzymes or bacteria to remove the toxic metabolic wastes. Recently, an enteric coated capsule containing live bacterial cells has been indicated to have good result for a limited number of predialysis kidney patients (stage 3 and 4). Its veterinary version has received some positive feedback from owners of felines or canines suffering from kidney failure.

It is also important to point out that in the use of probiotics, formulation is important to its success. Enteric version of delayed-release to allow optimal bacterial action in colon may work well as gut-based alternate kidney if the bacterial species selected are sensitive to habitat such as pH environment (gastric pH 1 versus intestinal pH 7). Also, dosing of culture in colony-forming unit (cfu) may also be relevant (billion cfu vs million cfu). Furthermore, an appropriate selection of bacteria can be crucial to the success of probiotics. As a result, any OTC probiotics for colon comfort or gas relief may not always be suitable for kidney patients in relieving symptoms of uremia. It may also be good to choose a symbiotics (i.e. a probiotics that also contains a prebiotics which can be some sort of fiber serving as nutrient for the probiotic bacteria). For probiotics to work, bowel movement is important. So, it would be better if we can check with our doctors before taking any probiotics and make sure we have an elimination mechanism for toxic waste.

Ref:

http://www.dovepress.com/potentials-and-limitations-of-microorganisms-as-renal-failure-biothera-peer-reviewed-article-BTT-recommendation1

http://informahealthcare.com/doi/pdf/10.1185/03007990903069173

http://www.kibowbiotech.com/pdfs/abstract%203.pdf

http://www.advancesintherapy.org/ait/images/uploads/AIT609_Ranganathan_for_web.pdf

http://www.kibowbiotech.com/pdfs/Probiotic%20Amelioration%20of%20Azotemia%20in%205-6th%20Nephrectomized%20Sprague%20Dawley%20Rats.pdf

L-arginine / L-citrulline in Blood Pressure Control

Hi,

In my earlier posting of agents for blood pressure (BP) control, I have referenced some papers on the use of L-arginine / L-citrulline for potential roles in BP reduction. Would like to emphasize that the use of these dietary supplements should be carefully discussed with healthcare providers and monitored. Both compounds act as precursors to facilitate nitric oxide production which may leads to endothelial dilation of blood vessels, thus lowering BP. However, they may also produce the tissue-damaging NO radical that is disadvantageous. Also, they may produce more nitrogenous waste products such as urea in the nitrogen cycle. It is hard to predict which way the two agents will act in our body upon consumption. That may be highly dependent on our physiological condition and health status. So, I would like to point this out here. There is always a risk of taking in agents of unclear mechanisms.