title: Medication is an additional source of phosphate intake in chronic kidney disease patients.
abstract: OBJECTIVE
  Hyperphosphatemia increases the risk of cardiovascular morbidity but the use of medicines as a source of phosphate has not been investigated yet. This study aims to explore the use of absorbable phosphate-containing drugs in CKD patients.
  
  
  RESULTS
  Incident CKD patients were identified within the Arianna database (containing data from 158,510 persons in Caserta (Southern Italy) registered with 123 general practitioners) from 2005 to 2011. Drugs prescribed to these patients were classified as phosphate-containing based on the summary of product characteristics (SPC), PubChem and Micromedex. The number and duration of prescriptions for these drugs as well as the overall intake of phosphate were estimated. Out of 1989 CKD patients, 1381 (70%) were prescribed 266 medicinal products containing absorbable phosphate over a median follow-up of 6 years (interquartile range (IQR) = 5.2-6.0). Most patients were prescribed ATC A (650; 47.1%) and C (660; 47.8%) phosphate-containing drug products targeting the gastrointestinal and cardiovascular system for a median of 232 (IQR: 56-656) and 224 (IQR: 56-784) days respectively.
  
  
  CONCLUSIONS
  Several medications, especially chronically prescribed ones, contain absorbable phosphate. This study's findings confirm the relevance of medicines as a phosphate source for the first time.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: J
authors.initials: J
authors.lastname: Sultana
authors.affiliation: Department of Pharmaceutical Sciences, University of Milan, Italy.
authors.forename: U M
authors.initials: UM
authors.lastname: Musazzi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: Y
authors.initials: Y
authors.lastname: Ingrasciotta
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Giorgianni
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ientile
authors.affiliation: Unit of Biostatistics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fontana
authors.affiliation: Department of Pharmaceutical Sciences, University of Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Minghetti
authors.affiliation: Caserta Local Health Service, Caserta, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Perrotta
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Santoro
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Savica
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Italy. Electronic address: trifirog@unime.it.
authors.forename: G
authors.initials: G
authors.lastname: Trifirò
mesh_terms: D002317:Cardiovascular Agents / Q000009:adverse effects / Q000737:chemistry; D002318:Cardiovascular Diseases / Q000209:etiology; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000737:chemistry; D006801:Humans; D054559:Hyperphosphatemia / Q000150:complications*; D007558:Italy; D010710:Phosphates / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D055553:Prescription Drugs / Q000009:adverse effects* / Q000737:chemistry; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents; D005765:Gastrointestinal Agents; D010710:Phosphates; D055553:Prescription Drugs
keywords: Cardiovascular risk; Chronic kidney disease; Drugs; Observational study; Phosphate