Effect of gastric acid suppression with pantoprazole on the efficacy of calcium carbonate as a phosphate binder in haemodialysis patients

Abstract

These results demonstrate clinical evidence for an adverse effect of gastric acid suppression on the effectiveness of calcium carbonate phosphate binders. Given their frequent co-prescription, this interaction may be a minor but common reason why some patients fail to control hyperphosphataemia. Clinicians should regularly assess the need for acid suppressants. Further studies are needed to investigate interactions with other phosphate binders.

Influence of pH and phosphate concentration on the phosphate binding capacity of five contemporary binders. An in vitro study

“…CC bound more phosphate in acidic conditions, which is in concurrence with the previous literature, probably because of its optimum solubility in an acidic milieu . Similar effects were demonstrated with concomitant use of pantoprazole and CC in vivo where serum phosphate was higher in the group using both CC and pantoprazole …”

“…Clinically this may indicate a negative influence of a higher pH value on phosphate binding capacity. This has been demonstrated after ingestion of a meal, with proton pump inhibitor use, and in patients with chronic gastritis and hypochlorhydria, as frequently encountered in CKD . CA/MC bound more phosphate with baseline pH 6.0 and therefore the limitations mentioned above seem to be of lesser importance for CA/MC.…”

“…However, our model lacks the complexity of the GI tract, and therefore extrapolation of our results can only be performed with great caution. In vivo, many factors induce variability in phosphate binding capacity, like distribution of phosphate binders, presence of bile salts, passage time through the stomach and intestines, the use of food additives, a variable phosphate absorption even when using the same binder, and a less acidic environment when proton pump inhibitors are used …”

“…There are multiple factors involved: non‐compliance to the dietary restrictions and phosphate binder use, bone derived phosphate and pharmacological aspects of phosphate binders. Furthermore, less acidic environment in use of proton pump inhibitors can be of influence, since lanthanum carbonate and calcium carbonate bind more phosphate in acidic surroundings . In depth knowledge of phosphate binders, like influence of pH, different phosphate intake and binder saturation, can be of great importance for clinical decision‐making.…”

Influence of proton pump inhibitors and histamine H2 receptor antagonists on serum phosphorus level control by calcium carbonate in patients undergoing hemodialysis: a retrospective medical chart review

“…There is a concern that administration of these gastric acid reducers (ARs) may interfere with the phosphate binding effect of CaC [8–11]. The dissolution rate of tablet formulation of precipitated CaC is strongly pH dependent.…”