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Актуальность. Тяжелая гипофосфатемия приводит к угрожающим жизни нарушениям. Данных о том, как влияет гипофосфатемия на конечные результаты лечения детей с острой дыхательной недостаточностью, до сих пор остается мало. Целью данного исследования было установить распространенность, причины и факторы риска гипофосфатемии у детей с острой дыхательной недостаточностью. Материалы и методы. С мая 2018 г. по май 2019 г. нами проведено проспективное когортное одноцентровое исследование на клинической базе кафедры анестезиологии и интенсивной терапии Львовского национального медицинского университета имени Данила Галицкого (отделение анестезиологии с койками интенсивной терапии КНП «Львовская областная детская клиническая больница «ОХМАТДЕТ») среди пациентов в возрасте от 1 мес. до 3 лет. Уровень фосфора сыворотки крови оценивали в 1-е (d 1 ), 3-и (d 3 ), 5-е (d 5 ), 7-е и 9-е сутки (d 7 и d 9 ). Клинические данные, публикуемые в данной статье, являются частью результатов клинического исследования «Diaphragm ultrasound and trends in electrolyte disorders and transthyretin level as a method to predict ventilation outcome in children: the prospective observational cohort study» (ISRCTN84734652; https://doi.org/10.1186/ISRCTN84734652). В отделение были приняты 57 пациентов с острой дыхательной недостаточностью, у 4 из них уровень фосфора не мониторировали. Таким образом, в исследование были включены 53 пациента. Результаты. Причинами острой дыхательной недостаточности у детей были: острая сердечная недостаточность — 2 пациента (3,8 %), сепсис — 5 больных (9,4 %), септический шок — 10 больных (18,9 %), энцефалопатия — 4 пациента (7,5 %), пневмония — 36 больных (67,9 %), острый обструктивный бронхит/бронхиолит/бронхиальная астма — 6 пациентов (11,3 %), бронхолегочная дисплазия — 2 пациента (3,8 %). Мы разделили всех пациентов на группы в соответствии с уровнем фосфора при поступлении. У пациентов с нормофосфатемией при поступлении на лечение (n = 6) уровень фосфора постепенно снижался и на 3-й день составлял 0,9 ммоль/л, на 5-й — 0,75 ммоль/л и на 7-й и 9-й дни — 0,72 и 0,65 ммоль/л соответственно. У пациентов с легкой гипофосфатемией при поступлении на лечение (n = 31, уровень фосфора — 0,68 ± 0,09 ммоль/л), на этапах исследования d 3 и d 5 уровень фосфора составлял 0,42 ± 0,05 и 0,40 ± 0,07 ммоль/л, соответственно, а к этапу d 7 достигал тяжелой гипофосфатемии и составлял 0,30 ± ± 0,04 ммоль/л; на этапе d 9 несколько увеличивался до 0,38 ± 0,08 ммоль/л. У пациентов с тяжелой гипофосфатемией при поступлении на лечение (n = 16, уровень фосфора — 0,22 ± 0,04 ммоль/л), на этапе d 3 уровень фосфора незначительно увеличивался до 0,28 ± 0,03 ммоль/л, на этапах исследования d 5 , d 7 и d 9 оставался практически неизмененным. Выводы. Частота выявления гипофосфатемии у детей с острой дыхательной недостаточностью при поступлении составляла 88,7 %, а на 5-й день лечения — 100 %. Причинами гипофосфатемии в данной когорте пациентов было сочетание различных механизмов: переход фосфора в клетки вследствие респираторного алкалоза и метаболического ацидоза при сепсисе, использование бета-адреномиметиков и кортикостероидов, рефидинг-синдром, а также невозможность обеспечить коррекцию гипофосфатемии при энтеральном питании.

Background: In adult acquired hypophosphatemic osteomalacia is generally associated with Biochemical abnormalities. Aims and Objective: To study Hypophosphatemic Osteomalacia in Neck femur fracture : A case series of 10 patients. Methodology: This was a cross-sectional study carried out in the department of Orthopedics from Aug 2015 to August 2016 in the patients who complained of Bilateral Hip (Groin) Pain and inability to walk were; Clinical, Radiological and all laboratory investigations whenever required were done and patients which were having final diagnosis of hypophosphatemic Osteomalacia in Neck femur fracture were included into the study during the study period. All details of the patients like age, sex and clinical features were noted. The data analysis was done by Excel software for windows 10. Result: In our study we have seen that the majority of the patients were in the age group of 60-70(40%), followed by 50-60 (20%), >70 (20%), 40-50 (10%), 30-40 (10%). The majority of the patients were Female (60%) and Males were 40%. The most common clinical features were Bilateral Hip (Groin) Pain (100%), Inability to walk (90%), Bilateral femur fracture (X-ray) in 30%, Unilateral femur fracture (X-ray ) in that Left was predominant i.e. 50% and Right were 20%. In the laboratory findings the all parameters were apparently normal except high Serum ALP level, low Serum Phosphorus level. Treatment and Outcome: Patient were treated conservatively they advised bed rest and supplementation of Tab. Endocal Forte OD, Protocol Supplement 2tsp with milk BD Adophos Sachet in ½ glass of Water QID, Tab. Rocaltrol (2.5) QID, average Patient were walking without support in an average 2 weeks, Pain decreased and also there is improvement of haematological parameter, X-ray shows signs of healing fracture. Conclusion: Hypophosphatemic Osteomalacia is commonly missed due to nonspecific signs and symptoms, but thorough investigation of blood and radiograph required for non-traumatic hip pain. This is rare condition needs high index of suspicion. This is totally curable by conservative Methods.

Background and Aims There were paucity of clinical evidence on target serum phosphorus levelsin early CKD. Present longitudinal study finds target phosphorus level and its association with FGF 23 in three different hyperphosphatemia managements groups. Method This one year, prospective, randomised controlled, open labelled study was conducted among three equally allocated treatment groups in 120 screened early CKD patients.Group1 Dietary phosphorus modificationn40; Group2 calcium-based phosphate bindersn40 and Group3 non calcium-based phosphate bindersn40.Three monthly dietary assessment, MDRD e-GFR, phosphorus, calcium, iPTH, Alkaline phosphatise and six monthly FGF23, 2D Echocardiography, X ray of chest and abdomen were performed. Association of three categories of phosphorus level up to 3.9 mg/dl, 4 to 5mg/dl and >5mg/dl, rate of progression of all parameters and correlation with FGF 23among all three groups were studied. Results At baseline, all clinical and biochemical parameters were equally distributed with a controlled nutritional phosphate among all groups. There was no significant difference of FGF23 in all the three categories of phosphorus level among all groups. Association of serum phosphorus at the level of 5 mg/dl was there with iPTH and e-GFR at one year. Over one year there were significant decline in serum phosphorus levels in Group1 p 0.02, Group2 p 0.00,Group3p 0.05;FGF23 was declined significantly only in group3p 0.00.Correlation of FGF23 was positive and negative with iPTH r 0.19,p 0.03 and e-GFR r-0.30, p 0.00respectively but not with phosphorus p0.13 Conclusion Serum phosphorus levels up to 5mg/dl has no effect on FGF 23 at early CKD stages. Although different treatment groups have significant phosphorus reduction, non-calcium phosphate binder has major impact on FGF23 reduction.

Background: Although hemodialysis vintage and serum phosphorus level adversely impact on outcomes in the field of general population on hemodialysis, it has not systematically studied whether these have similar prognostic impacts on clinical outcomes in population with chronic limb-threatening ischemia (CLTI). Methods: The current study retrospectively analyzed 374 hemodialysis patients with CLTI presenting ischemic tissue loss (age: 72.3±9.0 years, male: 73.3%, diabetes mellitus: 39.6%, Rutherford 5: 75.9%, 6: 24.1%, WIFI stage 4: 50.0%) primarily treated with endovascular therapy (EVT) between April 2007 and December 2016. Primary outcome measure was 1-year amputation-free survival (AFS), while secondary outcome measure was 1-year wound healing. Predictors for each outcome were evaluated by Cox proportional hazards model. Result: One-year rate of AFS and wound healing rate were 70.5±2.5%, and 57.1±3.0%, respectively. Multivariate analysis demonstrated that body mass index (hazard ratio [HR], 0.918; 95% confidence interval [CI], 0.859-0.981; p=0.012), non-ambulatory status (HR, 1.887; 95% CI, 1.222-2.913; p=0.004), lower serum albumin level (HR, 0.591; 95% CI, 0.414-0.844; p=0.004), WIfI stage 4 (HR, 1.782; 95% CI, 1.156-2.748; p=0.009) and longer vintages for hemodialysis with higher serum phosphorus levels (HR, 1.670; 95% CI, 1.099-2.537; p=0.016) were significantly associated with 1-year AFS (Figure), while WIfI stage 4 (HR, 0.713; 95% CI, 0.519-0.979; p=0.037) was associated and longer vintages for hemodialysis with higher serum phosphorus levels was close to significant association (HR, 0.684; 95% CI, 0.467-1.000; p=0.050) with 1-year wound healing. Conclusion: Longer hemodialysis vintage with higher serum phosphorus level would adversely affect clinical outcomes after EVT for hemodialysis patients with CLTI presenting ischemic tissue loss.

Background and Aims It is known that maintenance of function of arteriovenous fistula (AVF) is very important in the management of hemodialysis (HD) patients. Therefore, identifying a risk factor for decreased vascular access flow has a clinical relevance in real world practice. Although hyperphosphatemia plays a crucial role in the pathogenesis of vascular calcification, there is lack of studies evaluating the effect of hyperphosphatemia on AVF. This study investigated the impact of serum phosphorous (P) on vascular access flow in HD patients. Method Sixty-two maintenance HD patients who visited dialysis unit of Bundang CHA Medical Center from November 2016 to December 2017 were included in this study. Serum P levels were determined every month and time-averaged serum P was calculated. All patients had left arm AVF (side to side anastomosis) and vascular access flow was assessed by Transonic HD 03. Decreased vascular access flow was defined as less than 600 mL/min. Results The mean age was 57.9 ± 12.1 years, 32 patients (51.6%) were men. The mean serum P levels were 5.1 ± 1.1 mg/dL and the vascular access flow was 1,071.4 ± 504.2 mL/min. Decreased vascular access flow was observed in 14 of 62 patients (22.6%). In univariate analysis, higher serum P was significantly associated with decreased vascular access flow (odds ratio [OR]=2.089, 95% confidence interval [CI]=1.159-3.766, P=0.014). But there was no significant association of dialysis blood flow rate, ejection fraction on echocardiography and serum calcium (Ca) levels with vascular access flow. Multivariable analysis indicated that higher serum P was independently associated with greater risk of decreased vascular access flow (OR=4.012, 95% CI=1.651-9.711, P=0.002). Old age, reduced EF, low dialysis blood flow rate and higher serum Ca was not associated with vascular access flow. Conclusion This study demonstrated that higher serum P was the independent risk factor for decreased vascular access flow in maintenance HD patients. Serial monitoring of serum P may be helpful to stratify the risk of vascular access dysfunction in these patients.

The objective was to evaluate the effect of replacing milk with soymilk or calcium-fortified soymilk as a part of a meal on postprandial serum phosphorus levels. This study had a randomized crossover design. Ten healthy subjects were enrolled and consumed three test meals that contained either milk, soymilk, or calcium-fortified soymilk containing the same amount of calcium as milk. Blood samples were collected at 0, 30, 60, 120, 240 and 360 min and urine samples were collected from 0 to 360 min after consuming the test meal. Serum phosphorus levels decreased the most after the ingestion of the soymilk meal, and the least after the ingestion of the milk meal. After the ingestion of each meal, serum intact parathyroid hormone levels showed an initial drop followed by a gradual rise, and these changes were more pronounced for the soymilk meal than for the milk meal and the soymilk + calcium meal. Our study shows that replacing milk with soymilk as a part of a meal may suppress the postprandial elevation in serum phosphorus levels, even when the soymilk contains the same amount of calcium as milk.

ObjectiveRetrospectively analyze the clinical data of Corona Virus Disease 2019 (COVID-19) patients and explore the value of serum phosphorus level in evaluating the severity and prognosis of the disease.MethodsCOVID-19 patients transferred from the first emergency ward of Taiyuan fourth people’s Hospital from February 8 to March 3, 2020 were enrolled. The information of general conditions, clinical manifestations, laboratory indexes, nucleic acid detection and treatment were collected. The changes of blood phosphorus level and absolute value of lymphocytes in ordinary and severe/critical patients were recorded and compared.ResultsA total of 32 patients with COVID-19 were collected, including 12 cases of common type and 20 cases of severe/critical type. Before treatment, the serum phosphorus levels of the two groups were significantly lower than the normal level, and the serum phosphorus levels of the severe/critical patients were lower than those of the common type patients (t = 2.767, P < 0.010). After treatment, the serum phosphorus levels of the two groups reached normal, and there was no significant difference between the two groups (t = 0.231, P >0.819). The level of lymphocytes in severe/critical patients was lower than that in normal patients (t = 4.636, P < 0.001) before treatment. After treatment, the absolute value of lymphocytes in the two groups reached normal, and there was no significant difference between the two groups (t=1.208,P=0.237). There was a positive correlation between lymphocytes and serum phosphorus, and the correlation coefficient was 0.479.Conclusionhypophosphatemia is related to the severity of COVID-19, and strengthening the monitoring of serum phosphorus level of COVID-19’s severe/critical patients and correcting hypophosphatemia in time are of significance to improve the prognosis.

Background Elevated blood phosphorus levels are common and associated with a greater risk of death for patients receiving chronic dialysis. Phosphorus-rich foods are prevalent in the American diet, and low-phosphorus foods, including fruits and vegetables, are often less available in areas with more poverty. The relative contributions of neighborhood food availability and socioeconomic status to phosphorus control in patients receiving dialysis are unknown. Methods Using longitudinal data from a national dialysis provider, we constructed hierarchical, linear mixed-effects models to evaluate the relationships between neighborhood food environment or socioeconomic status and serum phosphorus level among patients receiving incident dialysis. Results Our cohort included 258,510 patients receiving chronic hemodialysis in 2005-2013. Median age at dialysis initiation was 64 years, 45% were female, 32% were Black, and 15% were Hispanic. Within their residential zip code, patients had a median of 25 "less-healthy" food outlets (interquartile range, 11-40) available to them compared with a median of four "healthy" food outlets (interquartile range, 2-6). Living in a neighborhood with better availability of healthy food was not associated with a lower phosphorus level. Neighborhood income also was not associated with differences in phosphorus. Patient age, race, cause of ESKD, and mean monthly dialysis duration were most closely associated with phosphorus level. Conclusions Neither neighborhood availability of healthy food options nor neighborhood income was associated with phosphorus levels in patients receiving chronic dialysis. Modifying factors, such as nutrition literacy, individual-level financial resources, and adherence to diet restrictions and medications, may be more powerful contributors than food environment to elevated phosphorus.

Background In recent years, the concentration of magnesium in dialysis patients has drawn an increasing amount of attention. Both hemodialysis and peritoneal dialysis may affect magnesium metabolism, but studies in this area are very limited. This study aimed to investigate the serum magnesium concentrations in hemodialysis patients and examine the factors related to the serum magnesium concentration, and to explore the effect of hemodialysis with conventional hemodialysis solution (magnesium ion concentration 0.5 mmol/L) on blood magnesium concentration. Methods In this single-center, retrospective study, linear regression models were established to explore the factors related to serum magnesium concentration in hemodialysis patients. Serum magnesium concentration was also compared before and after hemodialysis treatment. Results The data of 148 hemodialysis patients were collected and analyzed. The mean value of pre-hemodialysis total serum magnesium concentration was 1.11±0.14 mmol/L. The prevalence of hypermagnesemia was 73.65%, and 2 patients had hypomagnesemia (1.35%). Data analysis indicated that total platelet count, serum phosphorus level, serum creatinine, plasma albumin, and total serum cholesterol level were significantly related to serum magnesium concentration. After hemodialysis treatment, the serum magnesium concentration was significantly lower when conventional hemodialysis was used. After hemodialysis, the average decrease in the serum magnesium concentration was 0.14 mmol/L. Conclusions Most patients who received hemodialysis had mild hypermagnesemia when routine dialysate was supplied. Serum magnesium concentration is related to patients' nutritional status. Hemodialysis treatment can decrease the total serum magnesium concentration.

Chronic kidney disease (CKD) is a common disease in elderly dogs. The present study aims to evaluate the efficacy of a dietary supplement containing calcium carbonate, calcium-lactate gluconate, chitosan and sodium bicarbonate in dogs with IRIS stage 3 of CKD. Twenty dogs were enrolled in the study, ten were administered the new dietary supplementation for 180 days (T group) while the others were used as control group (C group). Haematologic, biochemical and urinalysis were performed every 30 days. A significant reduction in the T group compared to the C group in serum phosphorus level and increase in serum bicarbonate and ionized calcium values were recorded. The urine protein-to-creatinine ratio (UPC) was significantly lower in the T group at the end of the study compared to the C group. The tested supplement could be considered as a supportive treatment for dogs with advanced CKD.

Goats are extremely prone to many metabolic diseases including Postparturient Hemoglobinuria (PPH) and due to this disorder milk production and general health of goats get affected. Exact pathogenesis of this condition is yet not known but many risk factors are considered to be involved in hemoglobinuria and dropped serum phosphorus level followed by parturition is considered to be the most important one. In this paper, economic significance of goat, a case report and diagnosis based on hemogram and serum biochemistry report and the best available treatment protocols are discussed.

Objective: The aim of this study was to investigate the relationship between the mortality and serum phosphorus levels in patients with acute ischemic stroke. Methods: The data of 86 patients admitted to the study were analysed retrospectively. Results: A total of 86 patients (n:86) with acute ischemic stroke who were followed up in our hospital Neurology Intensive Care Unit (NICU). Fifty of 86 patients were survived and transferred to our service, then discharged. The number of patients who died was 36. The mean level of serum phosphorus of patients who died (2.77 ± 0.39) was significantly lower than that of the living patients (3.14 ± 0.20) (p

Calcium and its compounds play an important role in the regulation of many functions of the body. The concentration of calcium ions in the serum is one of the important constants of homeostasis. The objective of the research was to study the level of total calcium, ionized calcium, and phosphorus in patients with stage II hypertension and generalized periodontitis of II degree of severity, depending on the method of treatment. Materials and methods. The main group consisted of 70 patients with generalized periodontitis of II degree of severity and stage II hypertension who were divided into 4 groups. The comparison group consisted of 30 patients suffering from generalized periodontitis of II degree of severity without hypertension who were divided into similar 4 groups depending on age and type of treatment. The control group included 17 patients of corresponding age with healthy periodontium and without somatic pathology. Results. Twelve months after starting treatment, in younger patients of the main group receiving basic therapy, serum phosphorus level increased by 0.03 mmol /l, and in the older ones, it increased by 0.04 mmol/l. In younger and older patients of the comparison group, serum phosphorus level increased by 0.05 mmol/l. The patients who received basic therapy in combination with the proposed scheme of treatment had higher level of phosphorus than those who received basic therapy only. Twelve months after starting treatment, serum level of total calcium decreased in young and older patients of the main group and comparison group receiving basic therapy. An obvious improvement of treatment 12 months after its starting was observed in all the patients of the main group and comparison group who received basic therapy in combination with the proposed scheme of treatment. Conclusions. The improved treatment scheme was more effective for treatment of generalized periodontitis of II degree of severity in patients with stage II hypertension.

We report a case of severe generalised muscle weakness in a 66-year-old man who underwent revision of left knee arthroplasty. On postoperative day 1, he developed non-focal muscle weakness and shortness of breath which progressed over a 6-hour period. Serum phosphorus level was severely low at 0.5 mg/dL, along with mild degree of hypokalaemia, hypocalcaemia and hypomagnesaemia. His symptoms completely resolved after emergent phosphorus replacement. The authors believe this case is of educational interest to physicians as generalised muscle weakness is an uncommon presentation of severe hypophosphataemia. In a postoperative setting, hypophosphataemia is often multifactorial, thought to result from combination of perioperative catecholamine surge, administration of saline, diuretics, glucose and antacids, poor oral intake and respiratory alkalosis secondary to pain. We report this case to raise awareness among physicians on severe phosphate imbalance as the primary aetiology for acute generalised muscle weakness and respiratory failure, especially after a surgery.

PubMedID: 26875487 Hypophosphatemia has been found to be associated with multiple organ dysfunction. In this study we aimed to investigate the association between low serum phosphorus and acute heart failure. A total of 213 subjects, 101 patients with acute heart failure and 112 healthy subjects were included in this case-control study. Serum phosphorus levels, calcium levels, and PTH concentrations were measured. Ejection fraction percentages, pulse rates, systolic and diastolic blood pressures were recorded. The groups were similar in terms of age and gender (p=0.067 and 0.995, respectively). The phosphorus levels and ejection fraction percentages of the patients with heart failure were lower than for the healthy subjects (p?,0.001). Frequency of hypophosphatemia was higher in the heart failure group (p?0.001). There was a strong relationship between low serum phosphorus level and acute heart failure (OR 9.85, CI 95% 3.6-26.3, p?,0.001). The phosphorus level of patients with acute heart failure was found to be low in this study. Therefore, the phosphorus level should be controlled in patients with acute heart failure and phosphorus supplementation can be a complimentary treatment for these patients. © 2015, Center for Academic Publications Japan. All rights reserved.

Background: The objective of the study was to determine association of inadequacy of vitamin D level with low energy fractures of distal radius and its predictors in young patients in Karachi Pakistan.Methods: Cross-sectional study was conducted on 220 young patients, visited hospital with low energy fracture of distal radius. A questionnaire was designed and filled after taking consent includes details regarding age, gender, occupation, area of skin and sun exposure duration, dietary habits, type of clothing and residence used. Serum Vitamin D3 levels were determined and compared with serum calcium levels, serum phosphorus and alkaline phosphatase levels. Results: Among 220 patients ranging from 12-45 years, mean 28±23.33 SD. Female were 172 (78.18%). Mostly have history of fall 127 (57.72%) and RTA 63 (28.63). Sun exposure duration in majority of participant was 1-2 hour/day 132 (60%). Variable coloured clothes used by majority participant 135 (61.36%) and variable fabric 102 (46.36%). 202 (91.8%) patients had deficiency of vitamin D and correlated with duration of sunlight exposure significantly, also with exposure of large skin area, dietary consumption of vitamin D rich food and worn variable clothing colours. Serum phosphorus level and serum alkaline phosphatase level were negatively correlated with vitamin D significantly whereas positively correlated with serum calcium.Conclusions: Prevalence of vitamin D deficiency is very high in low energy fracture of distal radius in young population and sun exposure duration found to be most common predictor of inadequate D levels. A national food fortification program and campaign of public awareness to increase sunlight exposure and increase intake of vitamin D rich food are urgently needed.

Maintenance dialysis patients at our hospital who had been receiving lanthanum carbonate (LC) chewable tablets were switched to the same dosage of the granules, and the differences in serum phosphorus (P) levels were compared, together with stratifying patients at the baseline characteristics. Compared to average serum P level of 5.48 mg/dL for 2 months prior to switching, the average level for 2 months after switching was 4.99 mg/dL (P = 0.049). For patients who were under 60, serum P levels were significantly improved after switching (P = 0.016), and for patients who were concomitantly taking many kinds of medications, a correlation to high reductions of serum P level after switching was shown (R = -0.635, P = 0.015). In order to maximize pharmaceutical potential of LC, we think that it is not only necessary to provide patients with how to take the medication, but it is also important to take into consideration the patients' baseline characteristics.

Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease who undergo hemodialysis and endothelial dysfunction is an early key step in the development of atherosclerosis. The aim of this study was to investigate the effect of thrice-weekly in-center nocturnal hemodialysis (INHD, 8 h per session and three sessions per week) and conventional hemodialysis (CHD, 4 h per session and three sessions per week) on endothelial dysfunction in patients with end-stage renal disease. 32 INHD and 58 matched CHD patients were enrolled, baseline and 12-month measures of blood pressure (BP), serum calcium and phosphorus, serum intact PTH (iPTH) and brachial artery flow-mediated dilation (FMD) were collected and analyzed. Baseline characteristics were similar between groups except that serum phosphorus and calcium × phosphorus were higher in the INHD group. At the 12-month follow-up, there was a significant increase in FMD (6.0 ± 1.5% to 7.1 ± 1.8%, P

Gurbuz, Y., Cetin, M. and Sengul, T. 2009. Effect of phytase supplementation on performance, tibia ash and serum P in broilers fed diets with different levels of phosphorus. J. Appl. Anim. Res., 36: 137–140. In order to determine the optimal concentration of phytase and available phosphorus (aP) supplementation in broiler diets; 0.13%, 0.26% and 0.40% aP contents, each supplemented with 400, 800 and 1200 IU/kg phytase respectively, were tested against a control diet of 0.49% aP with no enzyme addition. Birds performed significantly better with control diet with sufficient phosphors concentration. The diet of 0.13% available aP with 400 IU/kg enzyme concentration (A) had lowest serum phosphorus level and tibia ash content in broiler chicken. No remarkable difference, available was observed in feed utilization efficiency among the experimental diets. However, costly aP could be saved by feeding it at the lowest level with highest level of phosphatase.

The evolution of our understanding of the biological impact of vitamin D is briefly reviewed, with a focus on the physiology and endocrinology of the vitamin D system. This chapter attempts to bring the molecular discoveries in vitamin D metabolism and mechanisms of action into focus on known physiology and endocrinology. The latest developments on metabolism of vitamin D, the enzymes involved, and the genes responsible are presented. The impact of the molecular discoveries on current views of the importance of vitamin D in public health is also presented.

Background: Increased mortality of hemodialysis (HD) patients is associated with chronic kidney disease-mineral and bone disorders (CKD-MBD), and therefore, their correction may improve patient survival. Differences in targets recommended by KDOQI and KDIGO CKD-MBD guidelines directed us to compare the relative numbers of patients achieving these targets and to examine possible associations between compliance with the targets and patient outcome. Methods: A total of 1,744 patients (61.2% males, aged 58.7 ± 12.5 years) dialyzed in 20 HD centers in Serbia were monitored for 3 years. The number of participants achieving KDOQI/KDIGO guideline targets for serum phosphorus, calcium, and iPTH was determined. The Cox proportional hazards model was used to select variables significantly associated with risk of time to death. Results: A majority of patients were dialyzed thrice weekly for 4 h; 86.3% of them used phosphate binders and 49.3% vitamin D3. Proportions of patients achieving KDOQI and KDIGO targets were 49.5 and 44.4% for phosphorus, 53.2 and 76.7% for calcium, 21 and 42.8% for iPTH. Multivariate Cox analysis selected serum phosphorus level outside the KDIGO target, as well as serum iPTH levels outside KDOQI and KDIGO targets as significant mortality predictors. Areas under the receiver operating characteristic curves showed that achievement of both guideline targets for iPTH had similar survival predictive values. Conclusion: Serum phosphorus levels outside KDIGO targets and iPTH levels outside both KDOQI and KDIGO targets were associated with a significantly higher risk of death. These findings may be useful in the management of CKD-MBD and for establishing local guidelines.

Background Little is known about the impact of holiday and other special-event meals on patients with chronic medical conditions. It is possible that patients are less adherent with dietary restrictions during such meals. We sought to determine the impact of Super Bowl parties on nutritional parameters among hemodialysis patients. Objective To determine the relationship between attending a Super Bowl party and subsequent change in serum phosphorus level, serum potassium level, interdialytic weight gain, and blood pressure. Design Retrospective cohort study. Setting Outpatient dialysis unit. Patients One hundred twenty-two chronic hemodialysis patients. Main outcome measures Patients were asked whether they had attended a Super Bowl party. Serum phosphorus level, serum potassium level, interdialytic weight gain, and predialysis blood pressure at the hemodialysis treatment after the Super Bowl and at the hemodialysis treatment 1 month previously were obtained by chart abstraction. Results The 15 patients who had attended a party had increased serum phosphorus levels (+0.5 mg/dL) and interdialytic weight gain (+1.1% of dry weight) from baseline. These increases were statistically significant (P values .005 and .02, respectively) compared with patients who did not attend a party. Attendees also had increased systolic blood pressure (+6 mm Hg) from baseline, but this was of marginal statistical significance compared with nonattendees (P = .14). Attending a party was not significantly associated with changes in serum potassium and diastolic blood pressure. Conclusions Attending a Super Bowl party is associated with adverse changes in several nutritional parameters. Although patients should not be discouraged from attending holiday and special-event meals, management of hemodialysis patients should include increased dietary counseling before holidays and special events and increased monitoring afterward.

This issue of Kidney International includes two important articles about serum phosphorus and its treatment. The article by Cannata-Andía and colleagues describes a rigorous observational study of the association between serum phosphorus level, phosphate binder use, and clinical outcomes including all-cause and cardiovascular mortality. The article by Mehrotra and colleagues addresses the association between serum phosphorus, socioeconomic status, and mortality among participants in the US-based KEEP program.

Background Hypophosphatemia may cause organ derangements in the surgical intensive care unit. The purpose of this study was to determine the impact of a repletion protocol for hypophosphatemia based on admission weight and phosphorus level. Study design All patients who presented to an 18-bed surgical intensive care unit with a serum phosphorus level of 2.2 mg/dL or less or who received phosphorus supplementation despite having normal levels were identified. In the preintervention phase between January and June 2001, 137 patients were retrospectively identified who met these criteria. A protocol was then designed giving a single intravenous dose of phosphorus based on weight and serum phosphorus. Repletion was given with sodium or potassium phosphorus based on presupplementation levels. After protocol implementation 141 patients met these criteria between September 2001 and February 2002, and treatment and postrepletion levels were followed prospectively. Results A total of 47 patients were repleted before the intervention with adequate followup and 22 (47%) attained a normal level. Supplementation success was 53% in moderate hypophosphatemia (2.2 mg/dL or less) and 27% in severe hypophosphatemia (less than 1.5 mg/dL). After protocol implementation, 111 patients were repleted with 84 (76%) correcting to a normal level (p = 0.002 compared with retrospective patients). Success was 78% in moderate hypophosphatemia and 62% in severe hypophosphatemia. Inappropriate supplementation of normal phosphorus levels decreased from 51 to 16 patients after protocol implementation. Conclusions A protocol based on weight and serum levels successfully treated both moderate and severe hypophosphatemia in the majority of critically ill patients. Protocol implementation also decreased unnecessary supplementation of normal phosphorus levels.

Background: Pulmonary tuberculosis is a chronic granulomatous bacterial infection caused by an acid-fast bacillus, mycobacterium tuberculosis or tubercle bacillus. It is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs so it is called pulmonary tuberculosis. There are many minerals synthesized in the body in an appropriate amount for specific work. If any disease occurs in the body then mineral level imbalance, like wise in pulmonary tuberculosis calcium and phosphorus levels disturb. The changes in Calcium and Phosphorus level is considered as an important factor in pathophysiology of pulmonary tuberculosis patient.Methods: The proposed study was conducted in Department of Biochemistry with association of Department of TB and Chest of S.P. Medical College and attached Hospital, Bikaner. There were 40 cases and 40 controls in the age groups from 15 to 50 years. We took fresh samples and performed required tests following standard protocol. By Analytical grade chemicals and standard serum Calcium and Phosphorus were estimated using enzymatic kit method by auto analyzer.Results: The Mean±SD of serum calcium and serum phosphorus levels were found 8.688±0.7155 and 2.833±0.6443 before chemotherapy and 9.163±0.4661 and 3.695±0.3471 after chemotherapy.Conclusions: Persons, who developed pulmonary tuberculosis disease, had increased serum calcium and serum phosphorus level after chemotherapy compared to before chemotherapy patients.

Increases in serum phosphorus levels and dietary phosphorus intake induces vascular calcification, arterial sclerosis and cardiovascular diseases. Limiting phosphorus intake is advisable, however, no assessment methods are capable of estimating dietary phosphorus intake. We hypothesized that urinary phosphorus excretion can be translated into estimation of dietary phosphorus intake, and we evaluated whether a 24-h urine collection method could estimate dietary phosphorus intake. Thirty two healthy subjects were recruited for this study. Subjects collected urine samples over 24 h and weighed dietary records. We calculated dietary protein intake and phosphorus intake from dietary records and urine collection, and investigated associations between the two methods in estimating protein and phosphorus intake. Significant positive correlations were observed between dietary records and UC for protein and phosphorus intake. The average intakes determined from dietary records were significantly higher than from urine collection for both protein and phosphorus. There was a significant positive correlation between both the phosphorus and protein difference in dietary records and urine collection. The phosphorus-protein ratio in urine collection was significantly higher than in dietary records. Our data indicated that the 24-h urine collection method can estimate the amount of dietary phosphorus intake, and the results were superior to estimation by weighed dietary record.

Summary Gastric dilatation-volvulus (GDV) was surgiclly induced in 10 dogs. Five of the dogs were pretreated with 50 mg/kg PO of allopurinol to determine the effect of xanthine oxidase inhibition on the pathophysiology of GDV. After 150 minutes, the GDV was corrected, and lactated Ringer's solution was administered intravenoulsy (resuscitation). Two hundred forty minutes after relief fo GDV, the dogs were euthanatized without recovery from anesthesia. Administration of allopurinol was associated with a reduced (P