Medications contribute to phosphorus load in kidney disease

  • Li J & al.
  • Nutr Diabetes
  • 3 Apr 2019

  • International Clinical Digest
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Takeaway

  • Many drugs commonly used by patients with chronic kidney disease (CKD) contain phosphorus, contributing to the intestinal load.

Why this matters

  • Medication-related phosphorus load is estimated to be
  • The authors cite a "lack of transparency" from pharmaceutical companies, which place phosphorus as an excipient on the label but neglect to specify the exact quantity.

    Key results

    • Phosphate levels in specific drugs varies by formulation (including branded vs generic) and manufacturer (e.g., amlodipine 10 mg: 7.9-165.6 mg; paroxetine 20 mg: 55.8-295.8 mg).
    • Over 20% of formulations for drugs in these categories contains phosphorus as an excipient:
      • Calcium channel blockers: 51%,
      • Pain medications: 44.8%,
      • Antipsychotics: 35.1%,
      • Vitamins: 29%,
      • Diabetes medications: 23.8%,
      • Beta blockers: 23%, and
      • Cholesterol-lowering therapy: 21%.
    • The most common form of excipient phosphorus was calcium hydrogen phosphate, which has lower bioavailability (70%-90%) than sodium hydrogen phosphate (100%), but remains a concern in CKD.

    Study design

    • Review highlighting the phosphorus content in medications prescribed to patients with CKD.
    • Funding: Bayer, National Natural Science Foundation of China, State Key Research Development Programme of China.

    Limitations

    • Incomplete manufacturer data.

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