COMPARISON OF CALCIUM ACETATE WITH CALCIUM CARBONATE AS PHOSPHATE BINDER IN PATIENTS ON MAINTENANCE HAEMODIALYSIS

Authors

  • Imran Saif
  • Abdul Halim
  • Ashfaq Altaf
  • Mohsin Saif
  • Muhammad Khalid
  • Dilshad Ahmad
  • Humera Imran

Abstract

Background: 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 (2.730.67 mmol/l vs. 2.320.28 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

References

Malluche HH, Mawad H. Management of

hyperphosphatemia of chronic kidney disease: lessons from

the past and future directions. Nephrol Dial Transplant

;17:1170–5.

Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG,

Chertow GM. Mineral metabolism, mortality, and morbidity

in maintenance hemodialysis. J Am Soc Nephrol

;15(8):2208–18.

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

;90:S33–8.

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

;83:66–73.

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

;60:6–11.

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

Nephrol 1992;3:96–102.

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