Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study)

Qunibi, Wajeh Y.; Hootkins, Robert; McDowell, Laveta L; Meyer, Micah S; Simon, Matthias; Garza, Rodolfo O; Pelham, Russell W.; Cleveland, Mark; Muenz, Larry R.; He, Donghong; Nolan, Charles R.

doi:10.1111/j.1523-1755.2004.00590.x

Cited by 196 publications

(171 citation statements)

References 34 publications

(44 reference statements)

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“…From previous studies in patients, acidosis might be expected with sevelamer hydrochloride (17,18,22). Sevelamer hydrochloride is a quaternary amine anion exchange resin with a non-absorbed polymer chain having covalently linked amino groups.…”

Section: Discussionmentioning

confidence: 99%

Pre-Treatment of Dairy and Breast Milk with Sevelamer Hydrochloride and Sevelamer Carbonate to Reduce Phosphate

et al. 2013

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♦ Introduction: Young children and infants with chronic kidney disease are at increased risk of hyperphosphatemia because of high intake of dairy products. Hyperphos phatemia leads to metastatic calcifications and an increased risk of cardiovascular complications. Sevelamer is an effec tive phosphate binder, but for children it has important practical disadvantages: it clogs enteral feeding tubes and can cause gastrointestinal complaints. Pretreatment of dairy products to reduce their phosphate content might solve those problems. ♦ Methods: Sevelamer hydrochloride and sevelamer carbon ate were suspended in various dairy products (cow's milk, breast milk, baby formula, and tubefeeding formula). Each product was tested with varying concentrations of sevelamer. After suspension, each sample was stored for 10 minutes, allowing the sevelamer to precipitate. The supernatant was decanted and analyzed for pH and for phosphate, calcium, magnesium, potassium, sodium, and chloride content. ♦ Results: We observed a significant decrease in the phosphate content of all tested products. With sevelamer hydrochloride, the phosphate reduction was 48% -91% in the various products, and with sevelamer carbonate, it was 22% -87%. The highest effectiveness was found in breast milk. A pH increase was found in all products. With sevelamer hydrochloride, a significant increase in chloride occurred. Notably, a significant decrease in calcium content (-75%) was observed in treated breast milk. ♦ Conclusions: Pretreatment of a variety of dairy products with either sevelamer hydrochloride or sevelamer carbon ate effectively reduced their phosphate content and might avoid troublesome ingestion of sevelamer in children. The change in pH with sevelamer hydrochloride was remark able, reflecting buffering mechanisms. The reduction in the calcium content of breast milk is a potential concern and should be carefully considered and monitored during clinical use of sevelamer.

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Section: Discussionmentioning

confidence: 99%

Pre-Treatment of Dairy and Breast Milk with Sevelamer Hydrochloride and Sevelamer Carbonate to Reduce Phosphate

et al. 2013

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“…Dietary phosphorus restriction or the use of oral phosphate binders is clearly followed by a significant fall in serum phosphorus (43,44). Therefore, serum phosphorus could be used as a surrogate of dietary intake in this population.…”

Section: Do the Risks Associated With High Serum Phosphorus In Ckd Pamentioning

confidence: 99%

Phosphorus and the Kidney: What Is Known and What Is Needed

Nadkarni

Uribarri

2014

Advances in Nutrition

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A major role of the kidneys is to maintain phosphorus homeostasis. High serum phosphorus has been linked to all-cause and cardiovascular mortality in chronic kidney disease (CKD) both before and after initiation of renal replacement therapy. Considering the clinical implications of uncontrolled hyperphosphatemia, maintenance of phosphorus concentrations within an optimum range is standard of care in this patient population. Recently, the epidemiologic associations between serum phosphorus and worse outcome have been extended to the general population. This becomes even more important in view of the increasing dietary phosphorus intake in the American diet due in large part to the greater consumption of foods processed with phosphate additives. A greater understanding of mechanisms and epidemiology of altered phosphorus metabolism and disease in CKD may help clarify the possible role of excess dietary phosphorus as a health risk factor in the general population. Adv. Nutr. 5: 98-103, 2014.

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“…However, reduced cardiovascular calcification may also result from dramatic reductions in total and LDL cholesterol, which occur during treatment with this bile acid sequestrant. Moreover, results of the Calcium Acetate Renagel Evaluation (CARE), a randomized, double-blind trial, demonstrated that Ca acetate is significantly more effective than sevelamer in controlling serum P and Ca ϫ P product to the recom- (19). Thus, it is conceivable that Ca acetate might in fact reduce the risk for CVC and mortality in dialysis patients as a result of better control of both serum P and Ca ϫ P product.…”

Section: Curbing Effects Of Factors That Promote Vascular Calcificationmentioning

confidence: 99%

Reducing the Burden of Cardiovascular Calcification in Patients with Chronic Kidney Disease

Qunibi

2005

Journal of the American Society of Nephrology

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Patients with chronic kidney disease (CKD) have a higher burden of atherosclerotic coronary artery disease compared with age-and gender-matched individuals with normal renal function. Cardiovascular calcification (CVC), a marker of atherosclerosis, is also more prevalent in these patients and is associated with serious clinical consequences. The pathogenesis of CVC is complex and includes factors that promote calcification and others that inhibit calcification. Thus, multiple therapeutic interventions should be used simultaneously to reduce the burden of calcification in patients with CKD. Thus far, interventional attempts have focused on curtailing the effects of factors that promote calcification such as management of known traditional factors for atherosclerotic coronary artery disease and on adopting specific approaches to normalize mineral metabolism, deliver adequate dialysis, and control serum cholesterol level. By contrast, interventions that may bolster the effects of inhibitors of calcification have not yet been studied well but are beginning to attract attention. Ideally, the goal of interventions is not only to slow or halt progression of calcification but also to reverse pre-existing calcification. Whether this goal is achievable is not currently known. This review examines the potential of various therapeutic interventions in reducing the CVC burden in patients with CKD. Moreover, the review is intended to stimulate more research in this area because the efficacy of these interventions has not been examined in controlled clinical trials.

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Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study)

Abstract: Calcium acetate controls serum phosphorus and calcium-phosphate product more effectively than sevelamer hydrochloride. Cost-benefit analysis indicates that in the absence of hypercalcemia, calcium acetate should remain the treatment of choice for hyperphosphatemia in hemodialysis patients.

Cited by 196 publications

References 34 publications

Pre-Treatment of Dairy and Breast Milk with Sevelamer Hydrochloride and Sevelamer Carbonate to Reduce Phosphate

Pre-Treatment of Dairy and Breast Milk with Sevelamer Hydrochloride and Sevelamer Carbonate to Reduce Phosphate

Phosphorus and the Kidney: What Is Known and What Is Needed

Reducing the Burden of Cardiovascular Calcification in Patients with Chronic Kidney Disease

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