The Treatment of Uraemic Hyperphosphataemia with Calcium Acetate and Calcium Carbonate: A Comparative Study

Schaefer, K.; Scheer, J C; Asmus, G.; Umlauf, Ellen; Hagemann, J; Herrath, D. von

doi:10.1093/ndt/6.3.170

Cited by 82 publications

(35 citation statements)

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“…The mean dose required to normal ize serum phosphorus was for CaAC 4.1 ± 0.36 g/day (957 ± 83 mg elemental Ca) and for the CaC0 3 4.01 ± 0.8g/day (1,590 ± 317 mg elemental Ca). This is similar to the re sults obtained by Shaefer et al [22] who needed 1.02 g/day calcium under CaAC and 1.88 g/day under CaCC>3 to con trol the serum phosphorus level. In a similar way Moriniére et al [23] needed 0.65 and 1.3 g/day, respectively.…”

Section: Discussionsupporting

confidence: 90%

“…In the first, Shaefer et al [22] concluded that calcium supplement is reduced to half the dose with CaAC to obtain the same binding effect as compared with CaCC>3; nevertheless, these au thors do not demonstrate a better serum phosphorus con trol or a lower incidence of hypercalcémie episodes. Morinière et al [23], in the other comparative study, ob tained results similar to ours; these authors did not observe any real advantage of CaAC over CaCC>3.…”

Section: Discussionmentioning

confidence: 99%

“…In acute studies of calcium and phosphate absorption, after a single meal by the intestinal lavage technique it was shown that in normal subjects [20] and dialyzed patients [21] CaAC bound twice as much phos phorus as CaCOi in quantities containing equivalent amounts of Ca; simultaneously, less calcium was ab sorbed [21], These results suggest that for half the dose of elemental calcium, acetate could control hyperphosphoremia as well as carbonate; therefore, the incidence of hypercalcemia is expected to be less. However, few pub lished studies have compared CaAC versus CaCO;* in clinical practice [21][22][23][24], and their results are conflicting. To our knowledge only two papers have compared the two treatments in the same group of patients [22,23].…”

Section: Introductionmentioning

confidence: 99%

“…However, few pub lished studies have compared CaAC versus CaCO;* in clinical practice [21][22][23][24], and their results are conflicting. To our knowledge only two papers have compared the two treatments in the same group of patients [22,23].…”

Section: Introductionmentioning

confidence: 99%

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Calcium Acetate versus Calcium Carbonate for the Control of Serum Phosphorus in Hemodialysis Patients

Almirall

Veciana²,

Llibre

1994

Am J Nephrol

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Recent in vitro and in vivo studies have shown that calcium acetate (CaAC) is a more effective phosphorus binder than, among other calcium salts, calcium carbonate (CaCO₃). More efficient binding allows serum phosphorus to be controlled with a lower dose; moreover, less calcium seems to be absorbed when CaAC is used. These properties could reduce the incidence of hypercalcemia; however, in clinical practice few reports have compared these two calcium salts, and results disagree. We evaluated in a 24-week prospective crossover study the clinical efficiency of CaCO₃ and CaAC in 10 selected chronic hemodialysis patients. Only 7 patients completed the study period. The patients were randomly assigned to start treatment with one of the two calcium salts; after 12 weeks they shifted to the other treatment. Serum analytical tests included weekly control of calcium, phosphorus, and alkaline phosphatase. PTH values (intact molecule) were obtained initially and at the end of every study period. The same good control of the phosphorus level (4.79 ± 0.6 vs. 4.94 ± 0.8 mg/dl) was obtained with CaAC (mean doses 4.1 ± 0.3 g/day) as with CaCO₃ (mean doses 4.01 ± 0.8 g/day). The mean serum calcium levels were similar (10.36 ± 0.5 vs. 10.20 ± 0.5 mg/dl). The dose of elemental calcium administered was significantly less with CaAC (957 ± 83 mg/day) than with CaCO₃ (1,590 ± 317 mg/day). However, the incidence of hypercalcemia (Ca > 11 mg/dl) was similar during the two treatment periods (13% with CaAC vs. 14% with CaCO₃). Also the incidence of Ca x P products > 65 was comparable (9.5 vs. 11.9%). In conclusion: 40% less calcium needs to be supplied when CaAC is used; however, the control of hyperphosphatemia and the frequency of hypercalcemia was the same as with CaCO₃. There is no clear advantage of CaAC over CaCO₃ in a medium-length (24 weeks) comparative study.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Calcium Acetate versus Calcium Carbonate for the Control of Serum Phosphorus in Hemodialysis Patients

Almirall

Veciana²,

Llibre

1994

Am J Nephrol

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“…Moreover, Mai et al (37) showed that phosphorus absorption decreased to 40% of the ingested load with calcium carbonate compared with 21.7% with an equivalent amount of calcium acetate. Thus, among patients with ESRD, calcium acetate binds approximately twice the amount of phosphorus per amount of calcium absorbed (38,39). This is believed to be attributable to the increased solubility of calcium acetate in both acid and alkaline solutions in vitro.…”

Section: Calcium Acetatementioning

confidence: 99%

Control of Hyperphosphatemia among Patients with ESRD

Coladonato¹

2005

Journal of the American Society of Nephrology

102

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Derangements of mineral metabolism occur during the early stages of chronic kidney disease (CKD). Hyperphosphatemia develops in the majority of patients with ESRD and has long been associated with progression of secondary hyperparathyroidism and renal osteodystrophy. More recent observational data have associated hyperphosphatemia with increased cardiovascular mortality among dialysis patients. Adequate control of serum phosphorus remains a cornerstone in the clinical management of patients with CKD not only to attenuate the progression of secondary hyperparathyroidism but also possibly to reduce the risk for vascular calcification and cardiovascular mortality. These measures include dietary phosphorus restriction, dialysis, and oral phosphate binders. Dietary restriction is limited in advanced stages of CKD. Phosphate binders are necessary to limit dietary absorption of phosphorus. Aluminum hydroxide is an efficient binder; however, its use has been nearly eliminated because of concerns of toxicity. Calcium salts are inexpensive and have been used effectively worldwide as an alternative to aluminum. Concerns of calcium overload have led to the investigation of alternatives. Currently, only two Food and Drug Administration-approved noncalcium, nonaluminum binders are available. Sevelamer hydrochloride is an exchange resin and was not as effective as calcium acetate in meeting new guideline recommendations in one double-blind clinical trial. Lanthanum carbonate is a rare earth element and has been studied less extensively. Concerns of long-term administration and toxicity exist. Furthermore, these agents are significantly more expensive than calcium salts, which may contribute to patient noncompliance.

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Phosphate binders for preventing and treating bone disease in chronic kidney disease patients

Navaneethan¹,

Palmer²,

Vecchio³

et al. 2006

The Cochrane Database of Systematic Reviews

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The Treatment of Uraemic Hyperphosphataemia with Calcium Acetate and Calcium Carbonate: A Comparative Study

Cited by 82 publications

References 0 publications

Calcium Acetate versus Calcium Carbonate for the Control of Serum Phosphorus in Hemodialysis Patients

Calcium Acetate versus Calcium Carbonate for the Control of Serum Phosphorus in Hemodialysis Patients

Control of Hyperphosphatemia among Patients with ESRD

Phosphate binders for preventing and treating bone disease in chronic kidney disease patients

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