Hyperphosphatemia is the key abnormality that sets off a cascade of metabolic events in chronic kidney disease (CKD). End stage renal disease (ESRD) patients that undergo Continuous Ambulatory Peritoneal Dialysis (CAPD) uses the peritoneal membrane for solutes filtration and clearance. The differences on the evaluation of peritoneal membrane transport status can affect the rate of toxin removal – serum phosphorus, from the systems. The present study aimed to determine the prevalence of CAPD patients presented with high phosphate level after starting the treatment, to identify the risk factors associated with hyperphosphatemia and to find the significant correlation between the phosphate level and the PET characteristics. A retrospective study was
applied for this research where the medical records of patients were reviewed and analyzed between January 2011 to December 2016. Data were collected successfully from 74 adult CAPD patients (41 male, 55.4% and 33 females, 44.6%), with mean age of 51.34 ± 13.75 year-old. In this study, Malays (n= 65, 87.8%) are the largest subjects recruited, while Chinese (n= 6, 8.1%) and Indians (n= 3, 4.1%) made the rest of the subjects. PET characteristics of CAPD patients showed 11 patients had high characteristic (14.9%), 24 high average (32.4%), 26 low average (35.1%) and 5 low (6.8%). There were 37 CAPD patients (50%) presented with high phosphate level after starting the treatment. Simple linear regression revealed that age (p = 0.0052), serum calcium (p= 0.0090), serum albumin (p = 0.0244), normalized protein catabolic rate (nPCR) (p =0.0126), intact parathyroid hormone (iPTH) (p = 0.0012), total creatinine clearance (p =0.0470), residual renal creatinine clearance (p = 0.390) and 24-hours urine volume output (p = 0.0060) were risk factors associated with hyperphosphatemia. Pearson’s correlation analysis showed there was no significant correlation between phosphate level and PET characteristics (r = -.232, p = 0.070) while there was significant correlation between PET characteristics and peritoneal solute clearance (r = 0.4748, p < 0.001). In conclusion, serum phosphate level may be associated with daily dietary intake, metabolism and dialysis adequacy. There was no correlation between serum phosphate level and PET characteristic suggesting the rate of the toxin removal might not been affected by the
differences on peritoneal membrane characteristics suggesting a further understanding on transport status in terms of its mechanism of toxin removal
Sapium baccatum is usually used as a timber in Malaysia. Its medicinal values are not well known and very little research has been conducted concerning the plant. Consequently, this study was conducted to observe toxicity effects of hexane extract of stem bark of S. baccatum. The toxicity effects were assessed through observation of physiological changes of the rats as well as through gross and histological examinations of its livers. The doses for the treated groups were given intraperitoneally for T2, T3 and T4 group which were given 100, 250 and 500 mg/kg, respectively. Meanwhile, control group (T1) was administered with 80% PEG 200 only. The observation period was 14 days. If the rat died, it was dissected and the liver was removed and examined. Some physiological effects observed include ataxia and hind-legs paralysis. The gross observations of the livers, growth of abnormal spots and connective tissues attachment to lobes of the livers were observed. The experiment was followed byhistopathological observation, which indicated the presence of abnormal hepatocytes with a distorted shape and undefined cell linings for T2 group. Results also indicated an increase in the distortion of hepatocytes, presence of massive cytoplasm and necrosis of hepatocytes for T3 and T4 groups. The results suggest that non polar extract of the stem bark of S. baccatum may promote toxic effects to the animals.