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Saint Louis University School of Nursing Baguio City

In Partial Fulfillment for the Requirements in Related Learning Experience

Journal on Chronic Kidney Disease

Submitted by: ABRENICA, Kimberly R. BSN 4-I2 LUMC MEDICAL WARD

Submitted to: Mrs. Joyce Kiat-ong Clinical Instructor

Date of Submission: February 12, 2012

While these observations are preliminary and require confirmation in a randomized." the authors concluded. MD. double blind. Savica and Dr. about half of them cannot reduce phosphate to recommended levels. Salivary phosphate returned to its original level by day 15 after discontinuing the chewing gum. it is very significant for me to be updated with new interventions and therapeutic management appropriate for the condition of my patient because this will improve the care plan. Reaction: As a student nurse and a future member of the health care team. Vincenzo Savica.com/2009/02/16/study-says-chewing-gum-beneficial-for-chronickidney-disease-patient/). of the University of Messina. sometimes remain unsuccessful in bringing about the desired result (http://www. and by the end of two weeks. the findings indicate that this chewing regimen might help control phosphate levels in patients with CKD. it will develop more efficient and safe therapeutic regimen for patients suffering from chronic kidney disease. This will also be a challenge for me to read articles from the book. Moreover. once it is already confirmed and presented to the public. we must have a scientific basis behind. salivary phosphate decreased 55% and blood phosphate decreased 31% from levels measured at the start of the study. The intake of various drugs with the aim of reducing the phosphate level in one¶s diet. of the University of Padova. II. Because patients with hyperphosphatemia also have high levels of phosphate in their saliva. in addition to using phosphate binders with meals. generally takes place in chronic kidney disease patients on dialysis. Summary of the Article: Hyperphosphatemia (high levels of phosphate in the blood) commonly occurs in CKD patients on dialysis.I. and Lorenzo A.healthjockey. The study authors declare CM&D Pharma Limited. This journal article will widen my horizon regarding the newly discovered medication regimen for CKD. could bring about a positive effect in such patients. Even when patients take medications to reduce phosphate acquired through their diet. It is very significant that in every intervention that we plan for our clients and in all the health teaching that we advise them. Study shows that the condition of high levels of phosphate in the blood. and surf the internet regarding topics on phosphate-binding chewing gum and CKD. Calò's team found that salivary phosphate and blood phosphate levels significantly decreased during the first week of chewing. known as hyperphosphatemia. These facts show that there is a need to determine if binding of the salivary phosphate during periods of fasting and the use of phosphate binders with meals. UK as a financial interest. PhD. placebo controlled study with more participants. Calò MD. in addition to their prescribed phosphate-binding regimen. whereas blood phosphate took 30 days to return to its original value. Italy and their colleagues recruited 13 dialysis patients with high blood phosphate levels to chew 20 mg of phosphate-binding chewing gum twice daily for two weeks between meals. they also state that their study findings further . Through this study. for their supply of the experimental chewing gum. magazines. as a support or complement to their medications. researchers tested whether there might be a benefit to binding salivary phosphate during periods of fasting. "Adding salivary phosphate binding to traditional phosphate binders could be a useful approach for improving treatment of hyperphosphatemia in hemodialysis patients. Dr. However. these researchers hint at the use of such chewing gums in chronic kidney disease patients with the aim of reducing their phosphate levels.

As for dieting.sciencedaily.php). "Chewing gum is an easy tool students can use for a potential academic edge.cnn.com /releases/2009/02/090212150854.212.com/news153672483.com/chewing-gum-could-aid-in-phosphoruscontrol/article/180805/  American Society of Nephrology (2009. chairman of the Head and Neck Institute at the Cleveland Clinic in Ohio (http://articles. especially in developing countries like the Philippines. Besides beating tooth decay.D.com/2009/02/16/study-says-chewing-gum-beneficial-for-chronickidney-disease-patient/ . it is not yet decided on how the packaging and marketing will be. one study from the Mayo Clinic finds that the body burns 11 calories an hour through working the jaw.306 adult Filipinos are suffering from CKD (http://www. it will be expected that it will be of high price. double blind. Michael Benninger.renalandurologynews.gum. The American Dental Association says on its Web site that "chewing sugarless gum for 20 minutes following meals can help prevent tooth decay" and recommends looking for gum with its ADA-approved seal. While these observations are preliminary and require confirmation in a randomized. The saliva produced in the mouth by the physical act of chewing can wash away acids and bacteria.com/docs/476194/CHRONIC-KIDNEY-DISEASE-The-PhilippineSituation).medicalnewstoday. thereby protecting teeth. This research study can be a basis for further researches regarding phosphatebinding chewing gum and CKD. the lead researcher and an instructor in nutrition at the Department of Pediatrics at Baylor College of Medicine. but no one can explain what impact that blood flow may have on cognition.com/2009-04-22/health/chewing. "Adding salivary phosphate binding to traditional phosphate binders could be a useful approach for improving treatment of hyperphosphatemia in hemodialysis patients.docstoc. we can¶t deny the fact that the economy we have right now is a big factor that contributes to this disease and other illnesses. III. Having something in the mouth likely calms the appetite. approximately 1. not all can be assured of its distribution.sciencedaily. it may be caused by diet.html). genetic.need to be confirmed in a randomized. but since it is a new discovery. The saliva flow can lead to an antacid effect in the stomach.benefits_1_wrigley-science-institutegum-eighth-grade-math-students/3?_s=PM:HEALTH). from http://www. lead researcher and physiological psychologist. There is also early evidence that gum chewing increases blood flow to the brain and the head by up to 25 percent. The authors concluded that adding salivary phosphate binding to traditional phosphate binders could be a useful approach for improving treatment of hyperphosphatemia in hemodialysis patients (http://www. lifestyle.com /releases/2009/02/090212150854. There are also studies that it is not only indicated for clients with CKD. References  http://www." says Craig Johnston. According to the statistics. thus. Chewing Gum Helps Treat Hyperphosphatemia In Kidney Disease Patients. Ph. the findings indicate that this chewing regimen might help control phosphate levels in patients with CKD. ScienceDaily.com/articles/138863. 2011. or environment. whatever is the cause.htm  http:www. independent research finds that gum can aid in reducing the symptoms of acid reflux disease. February 20)." explains Paula Geiselman.D. but it can also be for other beneficial purposes. "We decreased overall snack intake by 40 to 60 calories. placebo controlled study conducted on a larger group of patients (http://www." the authors concluded (http://www. Since this phosphate-binding chewing gum is still under further investigations and studies. Ph.healthjockey. placebo controlled study with more participants. double blind.. Retrieved March 11.htm).physorg." says Dr. "Overall gum chewing is more beneficial than it is harmful.

Retrieved November 8.com /releases/2009/02/090212150854. from http://www. February 12).org/content/20/3/639. http://articles.com/2009-04-22/health/chewing.sciencedaily.docstoc.cnn.com/docs/476194/CHRONIC-KIDNEY-DISEASE-The-PhilippineSituation  http://jasn.gum. 2011. Chewing Gum Helps Treat Hyperphosphatemia In Kidney Disease Patients.htm  http://www.com/resources/trial/68529/Double-Blind-Randomized-PlaceboControlled-Trial-Of-Fostrap-Chewing-Gum-In-Patients.benefits_1_wrigley-scienceinstitute-gum-eighth-grade-math-students/3?_s=PM:HEALTH  http://www. ScienceDaily.full  American Society of Nephrology (2009.asnjournals.bioportfolio.html .

mind April 22." But Nestle does admit that it may have some minor benefit. Investigators at Louisiana State University took 115 people who regularly chewed gum and fed them lunch. Another study adds to a growing body of evidence centering on chewing gum satiety and cravings. Ph. a nutritionist at New York University and author of "What to Eat. Related Literatures Chew on this: Gum may be good for body. "We decreased overall snack intake by 40 to 60 calories. "Chewing gum is an easy tool students can use for a potential academic edge. The data are part of a growing body of research that is giving Americans more reasons to pop some gum in their mouths and chew away. The other group did not chew gum at all." says Craig Johnston. Researchers at the Baylor College of Medicine took 108 eighth-grade math students from a Houston. eating healthier foods and trying to get some sleep. lead researcher and physiological psychologist. you're probably exercising. At least that's what research funded by the Wrigley Science Institute and being presented at the Experimental Biology 2009 meeting this week may have you think.He also reports that teachers anecdotally found that students who chewed gum required fewer breaks. the lead researcher and an instructor in nutrition at the Department of Pediatrics at Baylor College of Medicine. This newest study indicates that chewing gum can lead to better academic performance. The results were surprising. Also. following them for 14 weeks.D." explains Paula Geiselman. If it helps people eat less. Having something in the mouth likely calms the appetite. They found that those subjects."As for boosting academic performance. charter school and divided them into two groups. The gum-chewing students had a 3 percent increase in their standardized math test scores compared with those who did not chew gum. Nestle is familiar with results showing that feeding breakfast to hungry kids results in better schoolwork.One line of research suggests that gum should no longer be treated as contraband in schools.So. "The only reason to do these studies is to sell more gum. .D. who chewed gum three times hourly after lunch. Ph." warns Marion Nestle. the students who chewed gum had better final grades compared with the non-chompers. Chris Gajilan Special to CNN If you're looking to curb your appetite and improve your memory..D. One group chewed gum while doing homework and during test-taking situations. "Gum has no calories. paid better attention and stayed quiet longer than those who did not. Those things are all good. but maybe you should try chomping on a stick of sugar-free gum. 2009|By A. Texas. ate fewer high-calorie snacks.. it could be useful. is chewing gum the next in fad diet trends? Nutritionists and doctors are prescribing a healthy dose of caution. The chewers also reported decreased feelings of hunger and cravings for sweet foods. Ph. They measured their cravings before and after lunch. but she's quick to burst the bubble on the LSU study.IV.

and sales of sugar-free gum increased by more than 11 percent in 2008. people with chronic tension headaches or if you grind your teeth at night. It's definitely big business for what may be the world's oldest confection. it's open about its objective. "We're providing more reasons why consumers should chew. executive director of the Wrigley Science Institute. Ancient cultures around the world found their own forms of gum. But medical experts agree that gum chewing may be a tool." As manufacturers come up with new flavors.benefits_1_wrigley-scienceinstitute-gum-eighth-grade-math-students/3?_s=PM:HEALTH . While the Wrigley Science Institute declines to say just how much money it's spending on research. thereby protecting teeth. a substance that can have laxative effects at high doses.Nestle remains cautious about the funds being pumped into research by the gum industry. As for dieting. Sales topped $1. experts said that's a myth. as people struggle to chip away at the obesity problem. Michael Benninger. According to the American Dietetic Association. The American Dental Association says on its Web site that "chewing sugarless gum for 20 minutes following meals can help prevent tooth decay" and recommends looking for gum with its ADA-approved seal. "Sponsored studies almost invariably produce results favorable to the economic interests of the sponsor.cnn. chairman of the Head and Neck Institute at the Cleveland Clinic in Ohio. There is also early evidence that gum chewing increases blood flow to the brain and the head by up to 25 percent. "If you chew two sticks of gum at 20 calories instead of eating one to two chocolate chip cookies at 140 calories. The downsides are minimal. "There are people who probably shouldn't chew gum such as people with Temporomandibular Joint and Muscle Disorders. one study from the Mayo Clinic finds that the body burns 11 calories an hour through working the jaw. The saliva produced in the mouth by the physical act of chewing can wash away acids and bacteria. Interestingly. you can save 120 calories.com/2009-04-22/health/chewing. Mayans chewed on the sap of the sapodilla tree and called it chicle. but no one can explain what impact that blood flow may have on cognition. The Greeks called it mastiche. [They] are always designed in ways that fail to control for alternative explanations for the results.D. packages and brands. Besides beating tooth decay. The saliva flow can lead to an antacid effect in the stomach. tree sap is long gone from the current treat. or TMJ."Aside from the industry-funded findings.gum. independent research finds that gum can aid in reducing the symptoms of acid reflux disease.As for the notion that gum can stay in your stomach for years if swallowed.2 billion last year alone." Benninger adds. Gum is passed through the body and not digested." says Dr." said Gil Leveille. Native Americans introduced the sap of the spruce tree to early European settlers in New England." Source:http://articles. according to marketing research provider Information Resources Inc. there is solid evidence that gum chewing brings big benefits in dental health and acid reflux disease.. "Overall gum chewing is more beneficial than it is harmful. Today's gum consists of synthetic ingredients and is made sweet. It can be made sugar-free by adding sorbitol. gum's popularity continues to grow. Ph. "This isn't like smoking.

made with a phosphate-binding ingredient. MD. It was also noticed that a couple of days after curbing the use of these chewing gums. It is stated that these chewing gums. A considerable reduce in the amount of salivary phosphate and blood phosphate levels in these patients was noticed after this time period. Their findings are present online and will soon be published in the March 2009 issue of the Journal of the American Society Nephrology. known as hyperphosphatemia. along with continuing their prescribed phosphate-binding regime. and also prevent the onset of heart diseases. Italy. The saliva of such patients is also said to contain high levels of phosphate.com/2009/02/16/study-says-chewing-gum-beneficial-for-chronickidney-disease-patient/ . The study was conducted by Vincenzo Savica. double blind. Calò. along with Lorenzo A. However. for the purpose of this study. The condition of high levels of phosphate in the blood. these researchers hint at the use of such chewing gums in chronic kidney disease patients with the aim of reducing their phosphate levels. MD. were also asked to chew 20 mg of phosphate-binding chewing gum twice a day between meals. could bring about a positive effect in such patients. It is said that the salivary phosphate level reduced by about 55 percent. sometimes remain unsuccessful in bringing about the desired result. of the University of Padova. Through this study. placebo controlled study conducted on a larger group of patients. They assessed about 13 dialysis patients with high blood phosphate levels. for a period of 14 days. Thus the study investigators wanted to determine if binding of the salivary phosphate during periods of fasting and the use of phosphate binders with meals. they also state that their study findings further need to be confirmed in a randomized.healthjockey. generally takes place in chronic kidney disease patients on dialysis. These patients. Source: http:www. while the blood phosphate level reduced by about 31 percent in these patients. could help in maintaining proper phosphate levels in such patients. The intake of various drugs with the aim of reducing the phosphate level in one¶s diet.Study says chewing gum beneficial for chronic kidney disease patient A latest study states that chewing a certain type of gum can possibly aid in treating high phosphate levels in dialysis patients with chronic kidney disease. of the University of Messina. both salivary phosphate and blood phosphate returned to their original level. and colleagues. PhD.

Chewing Gum Could Aid in Phosphorus Control Alison Steiber. lanthanum carbonate. both CKD and HD patients have increased salivary phosphorus excretion compared with healthy controls. approximately 40% have serum phosphorus concentrations greater than 6. In CKD. serum phosphate concentrations higher than 6. Current protocols Current treatment for hyperphosphatemia in CKD patients involves dietary restriction of phosphate and the use of phosphate binders. Given the difficulty of dietary restrictions in phosphate control. PhD. conservatively. Binding salivary phosphorus could decrease the body phosphorus burden and thus lower serum phosphorus. Serum phosphorus is similar to many tightly controlled biochemical indices of human metabolism in that at concentrations both higher and lower than physiologically normal mortality is increased. These interventions. Salivary phosphate has been shown to be inversely associated with GFR in CKD patients. depending on the amount of fast or processed foods consumed. . In fact. serum phosphorus begins to rise when glomerular filtration rate (GFR) falls below 30 mL/min/1. calcium acetate.5 mg/dL are associated with a 27% increase in the relative risk of death. pills that bind phosphate are commonly used. Saliva contains phosphate at a level five times that of serum.362:1312-1324) has suggested that an ideal binder is one that effectively binds dietary phosphate. have not been completely successful. salivary phosphorus concentration increases. Hyperphosphatemia in CKD patients is independently associated with both secondary hyperparathyroidism and cardiovascular disease. The cost of these binders is substantial: approximately $750 million worldwide. A new weapon: salivary phosphate However. These researchers have discovered a chewing gum that may come very close to being an ideal phosphate binder. Currently. the dialysis process also assists in phosphate control. has no side effects and no systemic absorption. as approximately 50% of patients do not achieve goals established by the Kidney Disease Outcome Quality Initiative. (J Am Soc Nephrol. Diet prescriptions that limit phosphorus and protein can achieve adequate control of both in predialysis patients. Common phosphate binders Tonelli et al (N Engl J Med. Savica et al. LD October 11. The binders can contribute significantly to patients' pill burden (up to around six pills per day). By the time patients are on hemodialysis (HD). 2009. including this author in previous columns. but this is extremely difficult to achieve. 2010 Phosphate disturbances have been widely discussed by many. In fact. and magnesium hydroxide. does not increase patients' pill burden. The typical western diet contains approximately 1000-1200 mg of phosphate per day with. RD.5 mg/dL. HD patients are educated about the importance of limiting phosphorus intake to 800-1000 mg per day. and they may be systemically absorbed. however. 2010. the commonly used phosphate binders are calcium carbonate. but this often is not the case with dialysis patients. an additional 500 mg/day from food additives such as monocalcium phosphate or sodium phosphate. thus as the GFR decreases. 20:639-644) have recently reported a new weapon in phosphate control. These binders are reasonably safe and moderately bind dietary phosphates. and is inexpensive. Calcium-based binders increase patients' serum calcium concentrations. In HD patients.73 m2. sevelamer hydrochloride. Food sources of phosphorus are similar to protein sources.

Chitosan-loaded gum shows promise Patients were instructed to chew the chitosan gum for 60 minutes during fasting periods in the morning and the afternoon and to use of sevelamer with meals. Unused pills and gum were returned at the end of the study to measure patient compliance with individual prescription.60 to 5. the impact on serum phosphate needed to be tested. serum phosphorus did not return to baseline levels until week 6 (7. The gum was only used during weeks 1 and 2. Source:http://www.renalandurologynews.25 mg/dL). the mean serum phosphorus level declined significantly from week 0 to 2 (from 7. These patients were educated about sticking to a 1. They found that a middle viscosity deacylated chitosan was able to effectively bind phosphate.55 mg/dL). Therefore. and does not contribute to patients' pill burden. the patients were given all the gum and sevelamer they would require throughout the study. Savica's group tested chitosan as a potential binder of salivary phosphate. Dr.With these facts in mind. is not believed to be absorbed systemically.com/chewing-gum-could-aid-in-phosphoruscontrol/article/180805/ . dialysis patients would have an inexpensive means to control phosphorus nonsystemically and which does not contribute to their daily burden. but sevelamer was used throughout the six weeks. If further research confirms the safety and efficacy of the chitosan gum. HD patients with serum phosphorus concentrations greater than 6 mg/dL were enrolled in the study. This new gum shows great initial promise. The results of this brief pilot trial showed no significant changes in serum calcium during the six weeks. a pilot trial was conducted over six weeks. however. Steiber is Coordinator of the Dietetic Internship/Master's Degree Program at Case Western Reserve University in Cleveland. The gum is inexpensive to manufacture. During the study. Additionally. This could greatly impact their quality of life and the risk of death.2 g protein/day diet six months prior to the study. However.

2009) ² Chewing gum made with a phosphate-binding ingredient can help treat high phosphate levels in dialysis patients with chronic kidney disease (CKD). and by the end of two weeks. salivary phosphate decreased 55% and blood phosphate decreased 31% from levels measured at the start of the study. "Adding salivary phosphate binding to traditional phosphate binders could be a useful approach for improving treatment of hyperphosphatemia in hemodialysis patients. MD. placebo controlled study with more participants. in addition to using phosphate binders with meals. according to a study appearing in the March 2009 issue of the Journal of the American Society Nephrology (JASN)." the authors concluded. February 12). Source: American Society of Nephrology (2009. 2011. of the University of Messina. the findings indicate that this chewing regimen might help control phosphate levels in patients with CKD.Chewing Gum Helps Treat Hyperphosphatemia In Kidney Disease Patients ScienceDaily (Feb. ScienceDaily. Even when patients take medications to reduce phosphate acquired through their diet. Savica and Dr.htm . Because patients with hyperphosphatemia also have high levels of phosphate in their saliva. whereas blood phosphate took 30 days to return to its original value. Dr. Italy and their colleagues recruited 13 dialysis patients with high blood phosphate levels to chew 20 mg of phosphate-binding chewing gum twice daily for two weeks between meals. 12. While these observations are preliminary and require confirmation in a randomized. of the University of Padova. from http://www. The study authors declare CM&D Pharma Limited. Vincenzo Savica. for their supply of the experimental chewing gum. Calò's team found that salivary phosphate and blood phosphate levels significantly decreased during the first week of chewing. Salivary phosphate returned to its original level by day 15 after discontinuing the chewing gum. UK as a financial interest. The results suggest that this simple measure could maintain proper phosphate levels and help prevent cardiovascular disease in these patients. researchers tested whether there might be a benefit to binding salivary phosphate during periods of fasting. and Lorenzo A. double blind. Calò MD.com /releases/2009/02/090212150854. Chewing Gum Helps Treat Hyperphosphatemia In Kidney Disease Patients.sciencedaily. in addition to their prescribed phosphate-binding regimen. Retrieved November 8. about half of them cannot reduce phosphate to recommended levels. Hyperphosphatemia (high levels of phosphate in the blood) commonly occurs in CKD patients on dialysis. PhD.

FOSTRAP Chewing Gum. FOSTRAP Chewing Gum. Outcomes Assessor).html . non-randomized study in patients with chronic kidney disease on hemodialysis.Double Blind Randomized Placebo Controlled Trial of FOSTRAP Chewing Gum in Patients With CKD and Hyperphosphatemia Summary The phosphorus content in saliva is increased in chronic kidney disease. FOSTRAP Chewing Gum. Intervention Model: Parallel Assignment. Placebo chewing gum Source: http://www. All subjects will participate in a 4 week chewing period followed by a 4 week follow up period. Caregiver. Control: Placebo Control. Study Design Allocation: Randomized. placebo.bioportfolio.com/resources/trial/68529/Double-Blind-Randomized-PlaceboControlled-Trial-Of-Fostrap-Chewing-Gum-In-Patients. controlled trial with an open label extension for those subjects with end stage renal disease (ESRD). Patients with ESRD will be randomized to receive either FOSTRAP 20 mg BID. Masking: Double Blind (Subject. randomized. We are testing this hypothesis using a chewing gum called FOSTRAP which has been shown to be effective in a small. Primary Purpose: Treatment Conditions Hyperphosphatemia Intervention FOSTRAP Chewing Gum. FOSTRAP 40 mg BID or matching placebo 2x/day. All subjects will then enter an open label 2 week extension phase in which they will receive FOSTRAP 20 mg TID. Description A double-blind. Endpoint Classification: Safety/Efficacy Study. Patients with chronic kidney disease (CKD) not on dialysis will receive either FOSTRAP 20 mg 3x/day or placebo TID for 4 weeks followed by a 4 week follow up period. We hypothesize that a chewing gum that binds salivary phosphorus would be a novel. Investigator. effective agent to reduce serum levels of phosphorus in patients with chronic kidney disease.