Excess aluminium cannot be easily eliminated by impaired kidneys. If these changes remain unchecked and unstable, progressive toxaemia and devastating domino effect repercussions occur to overall health. It is however found in compound form in both rock and soil. “They don’t urinate during hibernation, and by the time spring arrives, their kidneys are damaged and have lost most of their function.” At that point, the bears’ kidneys seem to regenerate themselves, returning to normal function during the spring and summer. Phosphorus levels must also be within normal range before prescribing this type of binder (see below), which presents a Catch-22 dilemma. During the process, it releases chloride, which means vets need to check serum chloride levels closely during treatment to prevent adverse heart, nervous system, blood oxygen and fluid imbalance effects occurring. Top subscription boxes – right to your door, © 1996-2020, Amazon.com, Inc. or its affiliates. There is precious little research to suggest this is exactly the same for dogs, but the mechanisms and illness progression seem ominously like-for-like. Dogs in advanced kidney failure should have no more than 10 mg of phosphorus in their diet per pound of body weight per day. Significantly, it targets the brain and endocrine system and triggers a cascade of events leading to inflammation, neurotoxicity and disease. It is worth noting that binders should always be given with food – and separately (by at least an hour) from other medications and particularly antacids, as absorption efficacy is seriously undermined. But in CKD (stage 3 or 4) the suggested phosphorus intake is 0.2% to 0.5%. The point when one begins to institute the use of phosphate binders in the management of chronic renal failure will vary from animal to animal. Credit: Photographer: Erik Lam. New research into alternative phosphate binders. Hyperparathyroidism (actually, in CKF it is known as Secondary Hyperparathyroidism) adds to or exacerbates the symptoms of chronic kidney failure. The apparent increase in calcium also further damages the kidneys and accelerates a complete failure of these organs. There are health risks to using phosphate binders, which largely depend on the type of binder and the blood values and current symptoms of the dog. The dose can rise to 27 mg per pound of body weight to reach phosphorus control in late stage kidney failure, and is on top of up to 1,000 mg of calcium per pound of food (needs careful calculation), contained in the food and/or given in supplements. Calcium-based binders are perhaps the exception to the rule, because if a dog’s blood test shows abnormally high calcium levels, it is eminently dangerous to then introduce even more calcium by giving a calcium-based phosphate binder. It may seem logical to try to increase calcium intake after a period of test-result deficiency, but as the inability to absorb calcium is a possible cause of the shortage (or indeed a possible cause of high serum calcium), it is much wiser to concentrate on lowering phosphorus to bring calcium under better control. Similar to the metal aluminium, lanthanum is absorbed in the intestine and accumulates in body tissues, especially in the liver, bone, muscle, kidney, and brain. In dogs, dietary phosphorus restriction has been shown to slow the progression of renal failure. While this research is generally all human-centred, there are usually consequential applications in the veterinary treatment of kidney failure. On the plus side of things, many studies and experts in the field suggest the levels of aluminium toxicity in dogs suffering from renal failure (and receiving aluminium-hydroxide), is probably over-stated. A good and effective binder will virtually eliminate phosphorus absorption … and, given what theorists and researchers in the field are saying, it is my assertion one is probably better started earlier than current convention. The third health concern is constipation. If phosphorus levels rise to 8.0mg/dL, the amount of aluminium hydroxide should progressively but cautiously increase to an upper-limit of 100 mg per pound of body weight (Larry Nagode DVM Ph.D. of The Ohio State University Veterinary College). This article outlines the reasons for phosphate binders, explains the decision-making process and hopefully helps support conversations you will need to have with your trusted vet. RAAS suppression. The problem with aluminium is it accumulates in the dog’s body and becomes toxic. “How does that happen?” Korstanje asks. Phosphate Diet group The life expectancy of cats with borderline naturally occurring CRF is 2.5 times longer when they are fed with phosphate restricted diets in combination, when needed, with phosphate binders. In his work ‘Lanthanum carbonate as a first-line phosphate binder’, the specialist in nephrology Tilman Bernhard Drueke says: ‘Lanthanum is a rare-earth trace metal with industrial and agricultural applications. Some of these types of supplement also contain undesired elements, such as high levels of sucrose and phosphorus. Phosphate binders make chemical changes to the phosphate compounds in food, turning the phosphorus element into an insoluble compound that cannot be absorbed into the body. It is important to mention that I am not a vet. The recommended starting dose of sevelamer hydrochloride is 2.4 g, 3.6 g or 4.8 g per day based on clinical needs and serum phosphorus level. Aluminium hydroxide is probably the most widely prescribed phosphate binder presently available. Pet Products to remove Excess Phosphorus for Dogs & Cats with Kidney Disease. $55.95 $ 55. Calcium is an essential and the most abundant mineral in a dog’s body, and the relationship between calcium and phosphorus is critical to overall well-being. Phosphate Binders 101. It's also possible your veterinarian will prescribe phosphate binders to link free-floating molecules. In turn, this slows the transit time of the compound and improves its phosphate-binding ability. ... Administration of phosphate binders. Consequently, it slowly starts to accumulate in the dog's body. The products include molecules which bind to phosphate in food, preventing the absorption of excess phosphates in the intestine so that they never reach the bloodstream. Phosphorous and calcium bind to create your dog's bones, so in a dog with high levels of phosphorous, it is possible they will also need to minimize calcium intake. When should I start my dog on a phosphate binder? Calcium-containing binders should be avoided in hypercalcaemic patients and in those receiving calcitriol. This began because it was found that phosphorus levels in saliva were ominously higher in human kidney failure patients – and, significantly, it was higher in saliva even before an abnormal rise occurred in blood phosphorus. In 2016, scientists discovered that using the chewing-gum approach combined with a traditional phosphate binder accentuates the effects of the binder and efficiently contributes to lower phosphatemia in human CKD patients (‘Phosphate binders for the treatment of chronic kidney disease: role of iron oxyhydroxide’ by Cernaro V, Santoro D, Lacquaniti A, Costantino G, Visconti L, Buemi A, Buemi M). Highly palatable liquid suspension, for an easier adminstration vs. capsules and tablets; Combination of two intestinal phosphate binders decrease dietary availability of phosphorus The best aluminum-based phosphate binders to use for renal dogs is aluminum hydroxide powder. PTH increasingly draws both calcium and phosphorus from bone as the blood pH drops, causing a generalised weakness of the skeleton and a heightened risk of fractures. ... Lanthanum is primarily cleared by the biliary and … Calcium Acetate: The dose of calcium acetate is dependent on blood values. The powder is tasteless and can be easily mixed with food. Studies tell us that controlling how much phosphorus dogs eat becomes a priority in later stages of the condition and phosphate binders become an increasingly essential element in battling the disease. Exclusively licensed by Phosphate Therapeutics, this is a novel phosphate binder based on proprietary ‘Interstitial Mineral Hydroxide’ technology using adipate-doped iron oxide at the core of the product, thereby allowing PT20 to act as a very high-capacity ‘phosphate sponge’. 4.8 out of 5 stars 569. One of the most promising avenues explored in recent years was the PEACH pivotal study of PT20 by scientists in Cambridge in the United Kingdom. In its day, this was ground-breaking research that seemingly addressed one of the biggest stumbling blocks involved in treating renal disease. After viewing product detail pages, look here to find an easy way to navigate back to pages you are interested in. It also enables proteins to undertake the necessary growth and repair of cells and tissues. InfoBarrel is a writing platform for non-fiction, reference-based, informative content. It can also be used to reduce stomach acid production. It is furthermore involved in a molecule being produced called ATP (adenosine triphosphate), which keeps a store of energy ready for constant use by the body. Calcium-based binders are losing some credibility among vets, not least because of the risks of hypercalcaemia and the demand for regular and more frequent blood testing. Some owners give their kidney failure dogs’ ground eggshells as a routine, without knowing the proper dosage, whether a phosphate binder is actually needed or whether calcium levels in the blood are abnormally high. It is a very expensive drug and often prohibitive due to that fact alone. Rubber jaw is a symptom worth checking for, as it provides vets with a warning of abnormal PTH and calcium levels, even when blood calcium seems apparently within normal range. I have also suggested this in previous articles on canine kidney failure. It is interesting to note that calcium blocks some aluminium absorption, which suggests there is an advantage to using calcium-based and aluminium-based binders in combination. However, there is now evidence that proves restricting phosphorus in the diet may have only minimal advantages unless it's started extremely early. Early Italian studies (2009) suggested a chitosan-loaded chewing-gum was successful in reducing blood levels, but the results of this study were found to have flaws and could not be replicated by other researchers. This effect is often contrary to what's actually needed and can lead to other complications. Doggy Play Pen - Keep Your Puppy Safe - Give Yourself a Break! “Black bears go into hibernation in the fall with healthy kidneys,” says Ron Korstanje, PhD, a researcher at the Jackson Laboratory in Maine, in an article on the Jackson Laboratory website. In trying to prevent or at least better manage complications resulting from disease progression, it is important to restrict phosphorus in the diet once creatinine reaches 1.4 - 2.0mg/dL in blood test results. These mechanisms involving parathormone (PTH), acidosis and the adverse mobilisation of calcium from bones are all involved in increasing the rate of damage. Calcium as a binder cannot be used if calcitriol is being used to prevent secondary hyperparathyroidism. There is also a dilemma faced by many vets that prefer to use calcium-based binders, because unless serum phosphorus levels are already within the normal range in blood tests, there is a danger the calcium and phosphorus will combine and precipitate in tissues. In early stage kidney disease, there is an opportunity to add calcium to the diet (at ratios of 3:1 of calcium to phosphorus) in the hope of bringing abnormal blood levels down in the short-term. sdamment@shire.com; PMID: 18698878 DOI: 10.2165/00003088-200847090-00001 Abstract Lanthanum carbonate is considered to … It also remarked that studies have found that subtle increases in serum phosphate levels, even within the normal range, are also associated with an increased risk for death in predialysis (where there is significant kidney impairment) and the non-kidney disease population. Having read many recent research documents, it seems clear to me that damaging changes are already present long before blood results show higher than normal phosphorus levels. A suitable starting dose per day is 15 mg per pound of body weight when phosphorus levels in the blood are below 6.0mg/dL. While trying to work out the best phosphate binder to treat a dog with chronic kidney failure, I have found there are far too many variables to give a definitive response. Save more with Subscribe & Save. ... can be … As all phosphate binders take some time to have an effect, dosages are best reassessed and increased when necessary at monthly intervals. When the kidneys start to fail, PTH concentrations rise while Vitamin D levels fall – and the rise in PTH alone causes many of the symptoms and ill-effects associated with chronic kidney failure (CKF). The lungs, bones and central nervous system are the primary targets of aluminium. In ‘Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice’, which is widely respected as an authoritative guide, the author Stephen P. DiBartola suggests that while sevelamer hydrochloride is a useful and promising development, there are studies that show calcium acetate is actually superior to it in controlling high serum phosphorus (hyperphosphatemia). Use of calcium containing enteric phosphate binders in dogs and cats receiving calcitriol should be avoided or monitored closely for hypercalcemia (total and ionized calcium concentrations). FREE Shipping by Amazon. Moreover, despite promising early study data, magnesium is not as good at binding with phosphorus as aluminium. There's a problem loading this menu right now. Renagel requires administering three times per day with meals. While the chewing-gum approach may not directly benefit dogs with the disease, it could lead to new and more suitable veterinary products being introduced in due course. These changes are responsible for some of the serious health problems seen in CKD and increase the rate of further kidney damage. Moreover, the rate of intestinal absorption of lanthanum is enhanced in chronic renal failure.’. The use of lanthanum carbonate (also free of calcium and aluminium) to bind phosphorus is a very recent development. And despite early diet intervention, a binder is best introduced within short succession if levels are not brought under good control. They all work in a similar way - some work like a sponge while others act more like a magnet drawing the phosphorus out. Reports of constant and profuse diarrhoea became common – and further studies also showed dogs had a very limited ability to excrete magnesium, causing a higher risk of toxicity likely in a shorter time-period than aluminium. Prime members enjoy FREE Delivery and exclusive access to music, movies, TV shows, original audio series, and Kindle books. The passage of time has shown that magnesium carbonate often needs giving with calcium-carbonate to have even a moderate phosphate-binding effect, but there are also enormous and debilitating side-effect trade-offs to this approach. Reports suggest they produce varied and unpredictable results, although many vets recommend PhosLo (available only by prescription) over Ipakitine because the latter is a chitosan-based product and really little more than a nutritional supplement with less than 10% calcium carbonate content. Are there any dangers in giving a phosphate binder to my dog? If these doses fail to have the desired effect or if calcium blood levels rise to abnormal levels, talk to your vet about switching to another binder. For most of these compounds, the measurable efficacy indicator is serum phosphate concentration. Calcium levels can stay apparently normal in CKD or they can go high or low – but these changes are often related to phosphorus levels, which should persist as the management priority. ... having only occasionally observed gastrointestinal problems in the form of nausea in dogs using it at “high doses” – and as for humans as discussed in the studies … The typical ratio of calcium to phosphorus in a healthy dog is somewhere between 1:1 and 2:1. Aluminum hydroxide (brand names: Alternagel®, Amphojel®) is an over-the-counter oral antacid and phosphate binder, most commonly used to treat high phosphate levels secondary to kidney dysfunction (abnormal or impaired function of the kidneys). Phosphate contains phosphorus. 4.4 out of 5 stars 263. Ipakitine (phosphate binder) for Dogs and Cats – 60g Tub Ipakitine is useful for reducing the levels of phosphates and other substances which are present in many normal foods, but which cause trouble for cats and dogs with reduced kidney function. The most commonly used intestinal phosphate-binding agents in dogs and cats contain aluminum as hydroxide, oxide, or carbonate salts.1 Aluminum-containing binding agents generally appear to be well-tolerated and safe in dogs and cats; as such, they probably represent first-choice drugs for phosphate binding. … It is easier to regulate phosphorus than try to deal with calcium changes, so dog owners are best advised to focus on this task in the hope of achieving effective control. (1) Effects of dietary phosphorus and protein in dogs with renal failure. This usually means from eating meat, fish, grains and other foods (including processed and natural products). In theory, lanthanum should not accumulate excessively in renal failure dogs because it's excreted in bile, but Drueke’s contrary concerns about absorption rates are noteworthy and the long-term implications and health risks are as yet untested and unknown. Ipakitine should be given every day to animals along with their normal food. … Decreasing ap… The researchers found notable tissue accumulation of lanthanum occurred at 2,000 mg per day at the end of a 52-week trial, and I would interpret that to mean that less than 2,000 mg a day is a better and slightly safer upper limit. One level spoonful (provided) contains 2.5 grams of Epakitin (300 g). The … Another problem is it's able to bind to other bodily substances such as bile acids, vitamins (D, E, K, and folic acid) and cholesterol as well as phosphorus, which are then all excreted at the same time. There is a lot of debate about this, but the consensus suggests a binder is best started when phosphorus blood level results climb and stay above 4.5mg/dL for more than a month despite restricting phosphorus in the diet. It's thought likely that the inflammation causes memory and learning issues in humans (possibly symptoms of slow-onset dementia), although there is very limited study facts to help confirm or deny the same process occurs in dogs. Cowgill) the authors concluded ‘… aluminium toxicity can occur in dogs with CKD that are supplemented with aluminum-based phosphate binders at dosage required to normalize serum phosphorus concentration.’ They advised any progressive decreases in MCV (red blood cell volume count) and microcytosis should be monitored in dogs treated with aluminum-based phosphate binders, as these are early indicators of aluminium overdose. The kidneys regularly extract any excessive amounts of phosphorus and discharge them in urine, and this function maintains a safe phosphorus-calcium balance in the body. There were no specific or common toxic symptoms identified in the study – and after stopping treatment using the drug, serum lanthanum levels slowly reduced. But deciding which binder to use and when to start one are not always straightforward decisions and current research is starting to question traditional advice. Mindy McCullough, MS, RD, LDN. There is another and completely different avenue of research being conducted into the role that saliva might play in phosphorus absorption. Also, it may add too much of this mineral to the blood, which may result in calcification (hardening) of tissues. Some meats, poultry, grains and vegetables are also moderately higher than their counterparts, so choose ingredients carefully when home cooking. It is also less expensive than products made for people such as Alternagel, Amphojel, Basaljel or AluCaps (last one is available in the UK). Apart from it being an essential building block for bones and teeth, phosphorus also assists in metabolising carbohydrates and fats. Polyuria and compensatory polydipsia 2. ... Ipakitine for dogs and cats. Yes, but using ground eggshells as a source of calcium carbonate is not always undertaken with enough care. Aluminium Hydroxide: Use aluminium hydroxide gel powder and mix it into food, to get the best results. Unfortunately, high PTH is not always discovered in CKD, because it can stay high even when phosphorus levels become normalised after using an appropriate phosphate binding treatment. Renagel is a pharmaceutical product for delivering sevelamer hydrochloride into the human body. Authors Stephen J P Damment 1 , Michael Pennick. Myalgia (muscle pain), muscular cramping, and peripheral oedema (swelling caused by fluid accumulation) are known short-term concerns and side-effects. While the studies and research conclusions all relate to chronic kidney failure in human patients, it is likely that the same mechanisms and outcome occur in dogs. The management of end stage renal disease inherently carries a large treatment burden for the patient and having an iron-based phosphate binder with such an apparently positive safety and efficacy profile at this stage of development suggests the product could be of high clinical value to both doctors and patients in the future.’. Find details on Hypophosphatemia in dogs including diagnosis and symptoms, pathogenesis, prevention, treatment, prognosis and more. The dose can rise to 45 mg per pound of body weight to reach phosphorus control in late stage kidney failure, and is on top of up to 1,000 mg of calcium per pound of food (needs careful calculation), contained in the food and/or given in supplements. My vet recommended I give my dog, who was diagnosed with Stage 4 Kidney disease, Mylanta tablets which are an aluminium based phosphate binder. In short, dogs could not survive without adequate amounts of phosphorus (see below for daily intake guidelines) – but on the other hand, excessive amounts circulating in the body without correction will lead to disastrous health consequences over time. Increased renal loss: Primary hyperparathyroidism ... Kovacic J (2007) Phosphorus and phosphate metabolism in veterinary patients. Renalzin and Fosrenol are prescription drugs used for the delivery of lanthanum carbonate in animals, although these products are mostly targeted towards cats than dogs. Unfortunately, excessive amounts of phosphorus disrupt calcium levels in the blood, and dangerous symptoms begin to develop as this process draws more and more calcium out of bones. I suppose the best advice is … know what you are giving your dog and check with your vet that it is the best there is, given current blood-test results. Regular blood testing is an absolute necessity and offers both vets and owners the opportunity to react quickly to abnormal results and change the type of binder prescribed. Plants extract phosphorus from the ground, and all human and animal life acquires the mineral from foods we eat. Owners should discuss the options available with their own vet who, armed with a comprehensive set of urine and blood test results, will recommend the best and most appropriate phosphate binder based on a case-for-case basis and taking into consideration any pertinent other health issues a dog might have. When discussing the management and treatment of canine kidney failure, owners are sometimes confused by the terms ‘phosphate’ and ‘phosphorus’. I would however suggest owners do not use ground eggshells as a phosphate binder, but consult their vet about prescribing a safer and more suitable alternative. Research has shown that vets and dog owners shouldn’t wait for phosphorus blood levels to markedly rise, but instead introduce a binder as soon as the level moves into the higher range of normal or the lower range of abnormal. Additional Artwork: Tony Booth. © Copyright 2008 - 2020 by My Passion Media Inc. One solution to the higher PTH is to give low doses of calcitriol. Phosphorus beneficially interacts with B vitamins, a process that assists the regulation and maintenance of heartbeats, muscle contractions, nerve signals and kidney function. The current thinking is that it may need much earlier intervention to restrict phosphorus (which will mean much earlier renal-damage detection and CKD diagnosis), thereby enabling a longer period of serum phosphorus control. Most dog food manufacturers list the amount of phosphorus in their products. PhosLo and Ipakitine are two of the most commonly used calcium-based phosphate binders. Early signs of CKD may be mild, even inapparent to the pet owner. There are also known common side effects including sometimes severe gastrointestinal issues. I will outline the risks of each type of binder further into this article. Opinions expressed by InfoBarrel writers are their own. All information is peer reviewed. Phosphate Binders in 2 Dogs with Renal Failure G. Segev, C. Bandt, T. Francey, and L.D. Phosphate binders prevent absorption of phosphorus consumed in the diet as well as bind phosphorus present in bile, saliva and intestinal secretions. In essence, binders typically combine with phosphate (from ingested food) in the gastrointestinal tract to create an insoluble compound, which cannot be absorbed and is instead excreted. Aluminum hydroxide (ALOH) is currently recommended by Board Certified Veterinary Internists at the University of Davis, veterinary hospital as the product of choice to use in pets to effectively bind and eliminate excess phosphorus from the body.It has effectively replaced Epikacin for this purpose. Calcium acetate is better, as it has a superior phosphorus-binding ability, requiring about 40% less calcium to bind the same amount of phosphorus. Perhaps the biggest drawback of sevelamer hydrochloride for many owners is the cost. Some owners use different sources of calcium, sometimes following veterinary advice – but not always. There are two leading "phosphate binders" on the market which can enhance or be used to mimic some effects of a phosphate-restricted renal diet. Historically, aluminum hydroxide was commonly used. One goal in the management of renal disease is to normalize blood phosphorus concentrations. The parathyroid hormone (PTH) regulates both phosphorus and calcium levels in dogs. Ipakitine should be given every day to animals along with their normal food. In comparison to aluminium (excreted largely by the kidneys), lanthanum is advantageously removed more through the hepatic system. These symptoms include increased thirst, increased urination, lack of appetite, weakness, vomiting, sluggishness, a swelling of the parathyroid glands in the neck, extreme fatigue and occasionally coma, urinary tract stones, poor body condition and progressive malnutrition. Moreover, the calcium carbonate obtained from ground eggshells is not a premium calcium-based binder. I used Purina 'FortiFlora'. Many pet owners observe that it is unreliable and can have variable effects. 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