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In Japan, calcimimetics and other phosphate binders such as lantanum carbonate are not available for patients on long-term hemodialysis (HD), so we prospectively evaluated the clinical efficacy of the combination of sevelamer hydrochloride and calcium carbonate (CaCO3) for hyperphosphatemia. The study group comprised 65 HD patients who had been administered CaCO3 (>or=1500 mg/day) for hyperphosphatemia [>or=6.0 mg/dL (>or=1.94 mmol/L)]. At the beginning of the study the dose of CaCO3 was reduced by 1500 mg/day and the patients divided into two groups according to the dose of additional sevelamer hydrochloride: group A 2250 mg/day; group B 3000 mg/day. Oral active vitamin D therapy was unchanged. Fourteen patients (21.5%) dropped out because of adverse effects and of the 51 remaining patients 35 (53.8%) suffered from gastrointestinal problems. Serum phosphate concentration decreased significantly [from 7.5+/-0.8 mg/dL (2.42+/-0.26 mmol/L) to 6.6+/-1.3 mg/dL (2.13+/-0.42 mmol/L), P<0.01] in group B only after the 8 weeks of combination therapy. The calcium-phosphate product (CaxPi) also decreased in group B only [from 74.4+/-13.4 mg2/dL2 (5.99+/-1.07 mmol2/l2) to 63.7+/-15.8 mg2/dL2 (5.13+/-1.27 mmol2/l2), P<0.001]. The combination of sevelamer hydrochloride and CaCO3 is a suitable regimen for hyperphosphatemia treatment in HD patients because it avoids both the hypercalcemia of CaCO3 and the adverse effects of sevelamer hydrochloride when each is used as single-drug therapy. The ability of sevelamer hydrochloride to decrease the serum phosphate concentration is 2/3 (2250/1500 mg) that of CaCO3.

The effects of being fed lauric acid on rumen characteristics were evaluated in a double 3 × 3 Latin square design using six Holstein steers with ruminal cannulas on a high grain diet. The steers were fed commercial concentrate (8.7 kg/day/steer) with one of three levels of lauric acid (0, 25 or 50 g/day/steer) and timothy hay (1.8 kg/day/steer). The feed intake and digestibility were determined. Ruminal fluid was collected at 3 h after feeding to determine chemical, physical and microbial parameters. An in vitro pure culture study was performed to determine the effects of lauric acid on Streptococcus bovis, a potent bloat‐ and acidosis‐promoting rumen bacterium. There were no differences in feed intake and digestibility among the treatments. The proportion of butyrate and the viscosity of the rumen fluid tended to be lowered (P < 0.08 and P < 0.09, respectively) and the stable ingesta volume increase was significantly decreased (P < 0.01) by the lauric acid feed. The abundance of protozoa and bacteria did not differ among the treatments. In the in vitro study, the growth of S. bovis was inhibited by the lauric acid (100 nmol/L) but it showed an adaptive growth to lauric acid in long‐term subculturing. The S. bovis that had adapted to lauric acid showed decreased viscosity and lactate production (P < 0.01) in culture with sucrose. These results indicate that supplemental lauric acid added to a high grain diet improves physical properties, possibly by altering the metabolic activity of S. bovis, and it may prevent the occurrence of feedlot bloat and acidosis in beef cattle.

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