COMPARISON OF CALCIUM ACETATE WITH CALCIUM CARBONATE AS PHOSPHATE BINDER IN PATIENTS ON MAINTENANCE HAEMODIALYSIS
AbstractBackground: Hyperphosphatemia is common in end-stage renal disease patients. Objective ofthis study is to compare the hypercalcaemic effect and phosphate binding power of calciumacetate and calcium carbonate in end-stage renal disease patients on maintenance haemodialysis.Methods: This randomised control trial was conducted in four phases with calcium acetate orcalcium carbonate. Sixty-four patients on haemodialysis were randomly divided into 2 groups.After a washout period of 2 weeks, each group was given calcium acetate or calcium carbonatefor 2 months. After another washout period the patients were crossed over and again receivedthese drugs for 2 months. Serum Calcium, phosphate, and albumin were analysed on Selectra Eauto analyser at completion of each phase of study. Hypercalcaemic effect was defined as serumcalcium >2.54 mmol/l, and phosphate binding power as serum phosphate <1.61 mmol/l. Results:Forty-one patients completed the study. Though lower dose of calcium acetate was used, itresulted in equally good control of hyperphosphatemia as compared with calcium carbonatetherapy [1.37 mmol/l (SD 0.33) vs. 1.46 mmol/l (SD 0.34), p=0.16]. Incidence of hypercalcaemiawas higher with calcium carbonate therapy (2.730.67 mmol/l vs. 2.320.28 mmol/l, p<0.01).Both drugs were well tolerated, but patients more frequently complained of muscle cramps whiletaking calcium acetate. Conclusions: It is concluded that calcium acetate has similar effect onserum phosphate levels as compared to calcium carbonate in patients on maintenancehaemodialysis. However, calcium acetate results in lesser frequency of hypercalcaemia ascompared to calcium carbonate. Tolerance to both drugs was similar, though patients complainedof more muscle cramps while taking calcium acetate.KEY WORDS: Calcium acetate, Calcium carbonate, Hyperphosphatemia
Malluche HH, Mawad H. Management of
hyperphosphatemia of chronic kidney disease: lessons from
the past and future directions. Nephrol Dial Transplant
Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG,
Chertow GM. Mineral metabolism, mortality, and morbidity
in maintenance hemodialysis. J Am Soc Nephrol
Kestenbaum R, Sampson JN, Rudser KD, Patterson DJ,
Seliger SL, Young B, et al. Serum phosphate levels and
mortality risk among people with chronic kidney disease. J
Am Soc Nephrol 2005;16:520–8.
William F. Finn. Phosphorus Binders: Relative Potency of
Available Agents [online]. 2005. [Cited 06/16/2005].
Available at: http://www.medscape.com/viewarticle/506489.
Qunibi WY, Nolan CR. Treatment of hyperphosphatemia in
patients with chronic kidney disease on maintenance
hemodialysis: results of the CARE study. Kidney Int Suppl
Cronin RE. Treatment of hyperphosphatemia in chronic renal
failure. In: UpToDate, Rose, BD (Ed), UpToDate,
Waltham, MA, 2005.
Wallot M, Bonzel K, Winter A, Georger B, Lettgen B, Bald
M. Calcium acetate versus calcium carbonate as oral
phosphate binder in pediatric and adolescent hemodialysis
patients. Pediatr Nephrol 1996;10:625–30.
Sheikh MS, Maguire JA, Emmet M, et al. Reduction of
dietary phosphorous absorption by phosphorous binders, a
theoretical in vitro and in vivo study. J Clin Invest
Caravaca F, Santos I, Cubero JJ, Esparrago JF, Arrobas M,
Pizarro JL, et al. Calcium acetate versus calcium carbonate
as phosphorous binders in hemodialysis patients (abstract).
Vienna, Austria: Proceedings of the XXVII Congress of the
European Dialysis and Transplant Association/ European
Renal Association; 1990:270.
Massih Naghibi, Fatemeh Nazemian, Omid Rajabi, Maryam
Hami. Comparison of phosphate lowering properties of
calcium acetate and calcium carbonate in hemodialysis
patients. IJPT 2006;5(1):73–6.
Ben Hamida F, El Esper I, Compagnon M, Moniere P,
Fournier A. Long term crossover comparison of calcium
carbonate as phosphorous binder. Nephron 1993;63:258–62.
Moniere P, Djerad M, Boudailliez B, el Esper N, Boitte F,
Westeel PF et al. Control of predialytic hyperphosphatemia
by oral calcium acetate and calcium carbonate. Nephron
Ring I, Nielsen C, Andersen SP. Behreness JK, Sodemann B,
Korneup HJ. Calcium acetate versus calcium carbonate as
phosphorous binder in patients on chronic hemodialysis: a
controlled study. Nephrol Dial Transplant 1993;8:341–6.
Delmez JA, Tindira CA, Windus DW, Norwood KY, Giles
KS, Nighswander TL, et al. Calcium acetate as a
phosphorous binder in hemodialysis patients. J AM Soc
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.