Tags

Type your tag names separated by a space and hit enter

Calcium salts in the treatment of hyperphosphatemia in hemodialysis patients.
Curr Opin Nephrol Hypertens. 2003 Jul; 12(4):373-9.CO

Abstract

PURPOSE OF REVIEW

Hyperphosphatemia in patients with end-stage renal disease leads to secondary hyperparathyroidism and renal osteodystrophy, and is independently associated with mortality risk. How hyperphosphatemia increases mortality risk is unknown but it may promote cardiovascular calcification. It is recommended that dialysis patients be treated to maintain normal serum phosphorus. Although calcium-based phosphate binders are cost-effective, their long-term safety has been questioned because of their postulated role in progression of cardiovascular calcification. In this regard, sevelamer hydrochloride has been recommended as an alternative phosphate binder. In this review, we will examine these issues and provide rational guidelines for the use of calcium-based phosphate binders.

RECENT FINDINGS

Results from the calcium acetate Renagel evaluation study indicate that calcium acetate is more effective than sevelamer in controlling serum phosphorus and calcium x phosphorus product in hemodialysis patients. However, in the Treat-to-Goal study dialysis patients treated with sevelamer had less progression of coronary and aortic calcification than patients treated with calcium-containing binders. The mechanism underlying the slower rate of progression of cardiovascular calcification in sevelamer-treated patients remains uncertain but may relate to decreased calcium loading or to dramatic reductions in LDL cholesterol.

SUMMARY

At present, evidence incriminating calcium-containing phosphate binders in the progression of cardiovascular calcification in end-stage renal disease remains largely circumstantial. As calcium acetate is more efficacious and cost-effective than sevelamer, it remains an accepted first-line drug. Treatment with sevelamer hydrochloride should be considered for patients with persistent hypercalcemia during calcium-based binder therapy despite appropriate adjustment of vitamin D therapy.

Authors+Show Affiliations

University of Texas Health Sciences Center, San Antonio, Texas, USA. nolan@uthscas.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

12815333

Citation

Nolan, Charles R., and Wajeh Y. Qunibi. "Calcium Salts in the Treatment of Hyperphosphatemia in Hemodialysis Patients." Current Opinion in Nephrology and Hypertension, vol. 12, no. 4, 2003, pp. 373-9.
Nolan CR, Qunibi WY. Calcium salts in the treatment of hyperphosphatemia in hemodialysis patients. Curr Opin Nephrol Hypertens. 2003;12(4):373-9.
Nolan, C. R., & Qunibi, W. Y. (2003). Calcium salts in the treatment of hyperphosphatemia in hemodialysis patients. Current Opinion in Nephrology and Hypertension, 12(4), 373-9.
Nolan CR, Qunibi WY. Calcium Salts in the Treatment of Hyperphosphatemia in Hemodialysis Patients. Curr Opin Nephrol Hypertens. 2003;12(4):373-9. PubMed PMID: 12815333.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Calcium salts in the treatment of hyperphosphatemia in hemodialysis patients. AU - Nolan,Charles R, AU - Qunibi,Wajeh Y, PY - 2003/6/20/pubmed PY - 2004/9/30/medline PY - 2003/6/20/entrez SP - 373 EP - 9 JF - Current opinion in nephrology and hypertension JO - Curr Opin Nephrol Hypertens VL - 12 IS - 4 N2 - PURPOSE OF REVIEW: Hyperphosphatemia in patients with end-stage renal disease leads to secondary hyperparathyroidism and renal osteodystrophy, and is independently associated with mortality risk. How hyperphosphatemia increases mortality risk is unknown but it may promote cardiovascular calcification. It is recommended that dialysis patients be treated to maintain normal serum phosphorus. Although calcium-based phosphate binders are cost-effective, their long-term safety has been questioned because of their postulated role in progression of cardiovascular calcification. In this regard, sevelamer hydrochloride has been recommended as an alternative phosphate binder. In this review, we will examine these issues and provide rational guidelines for the use of calcium-based phosphate binders. RECENT FINDINGS: Results from the calcium acetate Renagel evaluation study indicate that calcium acetate is more effective than sevelamer in controlling serum phosphorus and calcium x phosphorus product in hemodialysis patients. However, in the Treat-to-Goal study dialysis patients treated with sevelamer had less progression of coronary and aortic calcification than patients treated with calcium-containing binders. The mechanism underlying the slower rate of progression of cardiovascular calcification in sevelamer-treated patients remains uncertain but may relate to decreased calcium loading or to dramatic reductions in LDL cholesterol. SUMMARY: At present, evidence incriminating calcium-containing phosphate binders in the progression of cardiovascular calcification in end-stage renal disease remains largely circumstantial. As calcium acetate is more efficacious and cost-effective than sevelamer, it remains an accepted first-line drug. Treatment with sevelamer hydrochloride should be considered for patients with persistent hypercalcemia during calcium-based binder therapy despite appropriate adjustment of vitamin D therapy. SN - 1062-4821 UR - https://www.unboundmedicine.com/medline/citation/12815333/Calcium_salts_in_the_treatment_of_hyperphosphatemia_in_hemodialysis_patients_ L2 - https://doi.org/10.1097/00041552-200307000-00005 DB - PRIME DP - Unbound Medicine ER -