Calcium Carbonate as a Phosphate Binder in Patients with Chronic Renal Failure Undergoing Dialysis

Abstract

Phosphate binders that contain aluminum are frequently prescribed to treat hyperphosphatemia in patients with chronic renal failure, but an accumulation of aluminum can lead to osteomalacia. To evaluate the efficacy of calcium carbonate as an alternative phosphate binder, we studied 20 patients maintained on dialysis during three consecutive periods. In period 1, the patients took aluminum hydroxide for a month (mean dose, 5.6 g per day; range, 1.5 to 14.0). In period 2, they took no phosphate binders for a month, and in period 3, they took calcium carbonate (Os-Cal) for two months (mean dose, 8.5 g per day; range, 2.5 to 17). The mean (+/- SE) serum calcium level during period 1 was 9.6 +/- 0.2 mg per deciliter; this decreased slightly (to 9.3 +/- 0.1) during period 2 and increased to 10.0 +/- 0.2 during period 3. The mean (+/- SE) serum phosphorus level during period 1 was 4.8 +/- 0.1 mg per deciliter; this increased to 7.3 +/- 0.3 during period 2, but returned to the control value (4.8 +/- 0.2) during period 3. Six of the 20 patients continued to need aluminum hydroxide during period 3 for satisfactory control of hyperphosphatemia. Calcium carbonate successfully lowered serum phosphorus levels and raised serum calcium levels in the majority of our patients, thereby confirming that this agent may be a satisfactory substitute for traditional phosphate binders that contain aluminum. The possibility that long-term treatment could cause such side effects as metastatic calcification will require further investigation.

Comparative Effectiveness of Calcium-Containing Phosphate Binders in Incident U.S. Dialysis Patients

“…In chronic dialysis patients, higher serum phosphate concentrations are associated with coronary artery and aortic calcification (14). Whereas calcium carbonate was shown to reduce serum phosphorus in the seminal study of Slatopolsky et al, it became evident that such treatment raised serum calcium concentrations (6). The authors speculated that long-term treatment with calcium carbonate might lead to increased calcification, which was later corroborated by Goodman et al (14) Thus, it is important to determine whether lowering phosphorus by means of CCPBs yields net benefits or risks.…”

FGF-23 and Hyperphosphatemia in Dialysis Dependent Chronic Kidney Disease Patients

“…These patients were also provided with calcium carbonate and calcitriol tablets depending on their serum calcium and vitamin D levels. Calcium carbonate has been used extensively worldwide since the early 1980s because of its efficacy, tolerability, and affordability [29,30].…”

Concentração de cálcio no dialisato e hipercalcemia na DRC

“…7 Com o reconhecimento da toxicidade do alumínio, os quelantes com Ca passaram a ser utilizados para a maioria dos pacientes. 8 No entanto, hipercalcemia começou a ser observada, especialmente quando se associava ao calcitriol. Consequentemente, no final da década de 1980 e início da década de 1990, grande parte dos nefrologistas retornou ao uso de Cad de 2,5 mEq/L.…”