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The effects of calcium carbonate as the sole phosphate binder in combination with low calcium dialysate and calcitriol therapy in chronic hemodialysis patients.
J Am Soc Nephrol. 1992 Oct; 3(4):995-1001.JA

Abstract

Alternative phosphate binders, such as CaCO3, have been shown to be effective in the control of phosphate (P) retention in hemodialysis patients (HDP). Additionally, both oral (POC) and iv (IVC) calcitriol are purported to be of benefit in the control of secondary hyperparathyroidism. This investigation was undertaken to determine: (1) the effectiveness of CaCO3 as the sole P binder in combination with low (2.5 mEq/L) Ca dialysate; (2) the effects of discontinuing Al(OH)3 binders on both unstimulated and stimulated Al concentrations; and (3) the comparative parathyroid hormone (PTH) response to both POC and IVC in a large group of hemodialysis patients. One hundred ninety-four HDP completed part 1 of the study where CaCO3 was substituted for Al(OH)3 as the sole P binder for 6 months. A cohort of 49 HDP was given desferoximine (40 mg/kg) initially and 10 months after using CaCO3. In part 2, 54 HDP were given POC and 97 HDP were given IVC in dosages of 0.25 to 0.5 micrograms/day and 1.5 to 6.0 micrograms/wk, respectively, for an additional 6 months. In part 1, Ca and P were not different from baseline values observed with Al(OH)3 therapy. Ionized Ca increased (P < 0.05) and PTH decreased (P < 0.001) during CaCO3 therapy without vitamin D. In part 2, PTH declined 23% with IVC and was unchanged with POC in equivalent dosages (P < 0.05) at 3 months. By 6 months, PTH declined a total of 54% with IVC and was unchanged with POC. Ca, ionized Ca, P, and serum calcitriol were greater (P < 0.05) in the IVC group at 6 months. Serum Al concentrations for the entire 194 HDP fell 65% (P < 0.0001) over 12 months. In the 49 HDP cohort, serum Al fell 43.6% (P < 0.001) and stimulated Al concentrations decreased 68.7% (P < 0.0001) after 10 months. We conclude that: (1) CaCO3 is as effective as Al(OH)3 in controlling P, (2) a small decrease in PTH is observed with CaCO3 alone, (3) serologic evidence of Al excess is virtually eliminated, (4) PTH suppression with IVC is superior to that seen with POC in equivalent doses.

Authors+Show Affiliations

Emory University School of Medicine, Atlanta, GA.No affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

1450373

Citation

Oettinger, C W., et al. "The Effects of Calcium Carbonate as the Sole Phosphate Binder in Combination With Low Calcium Dialysate and Calcitriol Therapy in Chronic Hemodialysis Patients." Journal of the American Society of Nephrology : JASN, vol. 3, no. 4, 1992, pp. 995-1001.
Oettinger CW, Oliver JC, Macon EJ. The effects of calcium carbonate as the sole phosphate binder in combination with low calcium dialysate and calcitriol therapy in chronic hemodialysis patients. J Am Soc Nephrol. 1992;3(4):995-1001.
Oettinger, C. W., Oliver, J. C., & Macon, E. J. (1992). The effects of calcium carbonate as the sole phosphate binder in combination with low calcium dialysate and calcitriol therapy in chronic hemodialysis patients. Journal of the American Society of Nephrology : JASN, 3(4), 995-1001.
Oettinger CW, Oliver JC, Macon EJ. The Effects of Calcium Carbonate as the Sole Phosphate Binder in Combination With Low Calcium Dialysate and Calcitriol Therapy in Chronic Hemodialysis Patients. J Am Soc Nephrol. 1992;3(4):995-1001. PubMed PMID: 1450373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of calcium carbonate as the sole phosphate binder in combination with low calcium dialysate and calcitriol therapy in chronic hemodialysis patients. AU - Oettinger,C W, AU - Oliver,J C, AU - Macon,E J, PY - 1992/10/1/pubmed PY - 1992/10/1/medline PY - 1992/10/1/entrez SP - 995 EP - 1001 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 3 IS - 4 N2 - Alternative phosphate binders, such as CaCO3, have been shown to be effective in the control of phosphate (P) retention in hemodialysis patients (HDP). Additionally, both oral (POC) and iv (IVC) calcitriol are purported to be of benefit in the control of secondary hyperparathyroidism. This investigation was undertaken to determine: (1) the effectiveness of CaCO3 as the sole P binder in combination with low (2.5 mEq/L) Ca dialysate; (2) the effects of discontinuing Al(OH)3 binders on both unstimulated and stimulated Al concentrations; and (3) the comparative parathyroid hormone (PTH) response to both POC and IVC in a large group of hemodialysis patients. One hundred ninety-four HDP completed part 1 of the study where CaCO3 was substituted for Al(OH)3 as the sole P binder for 6 months. A cohort of 49 HDP was given desferoximine (40 mg/kg) initially and 10 months after using CaCO3. In part 2, 54 HDP were given POC and 97 HDP were given IVC in dosages of 0.25 to 0.5 micrograms/day and 1.5 to 6.0 micrograms/wk, respectively, for an additional 6 months. In part 1, Ca and P were not different from baseline values observed with Al(OH)3 therapy. Ionized Ca increased (P < 0.05) and PTH decreased (P < 0.001) during CaCO3 therapy without vitamin D. In part 2, PTH declined 23% with IVC and was unchanged with POC in equivalent dosages (P < 0.05) at 3 months. By 6 months, PTH declined a total of 54% with IVC and was unchanged with POC. Ca, ionized Ca, P, and serum calcitriol were greater (P < 0.05) in the IVC group at 6 months. Serum Al concentrations for the entire 194 HDP fell 65% (P < 0.0001) over 12 months. In the 49 HDP cohort, serum Al fell 43.6% (P < 0.001) and stimulated Al concentrations decreased 68.7% (P < 0.0001) after 10 months. We conclude that: (1) CaCO3 is as effective as Al(OH)3 in controlling P, (2) a small decrease in PTH is observed with CaCO3 alone, (3) serologic evidence of Al excess is virtually eliminated, (4) PTH suppression with IVC is superior to that seen with POC in equivalent doses. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/1450373/The_effects_of_calcium_carbonate_as_the_sole_phosphate_binder_in_combination_with_low_calcium_dialysate_and_calcitriol_therapy_in_chronic_hemodialysis_patients_ L2 - http://jasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=1450373 DB - PRIME DP - Unbound Medicine ER -