The Demise of Calcium-based Phosphate Binders-is This Appropriate for Children?

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2014 Dec 29

PMID 25543193

Citations 12

Authors

Lesley Rees

Rukshana Shroff

Affiliations

Soon will be listed here.

Abstract

In children with chronic kidney disease (CKD) optimal control of mineral and bone disorder (MBD) is essential not only for the prevention of debilitating skeletal complications and for achieving adequate growth, but also for preserving long-term cardiovascular health. The growing skeleton is particularly vulnerable to the effects of CKD, and bone pain, fractures and deformities are common in children on dialysis. Defective bone mineralisation has been linked with ectopic calcification, which in turn leads to significant morbidity and mortality. Despite national and international guidelines for the management of CKD-MBD, the management of mineral dysregulation in CKD can be extremely challenging, and a significant proportion of patients have calcium, phosphate or parathyroid hormone levels outside the normal ranges. Clinical and experimental studies have shown that, in the setting of CKD, low serum calcium levels are associated with poor bone mineralisation, whereas high serum calcium levels can lead to arterial calcification, even in children. The role of calcium in CKD-MBD is the focus of this review.

Citing Articles

A real-world analysis of the influence of age on maintenance hemodialysis patients: managing serum phosphorus with sucroferric oxyhydroxide as part of routine clinical care.

Rhee C, Zhou M, Woznick R, Mullon C, Anger M, Ficociello L Int Urol Nephrol. 2022; 55(2):377-387.

PMID: 35953565 PMC: 9859895. DOI: 10.1007/s11255-022-03327-w.

Nutritional Assessment and Management in Paediatric Chronic Kidney Disease.

Azzouz J, Safdar O, Awaleh F, Khoja A, Alattas A, Jawhari A J Nutr Metab. 2021; 2021:8283471.

PMID: 34676115 PMC: 8526268. DOI: 10.1155/2021/8283471.

Enteral Ca-Intake May Be Low and Affects Serum-PTH-Levels in Pre-school Children With Chronic Kidney Disease.

Schmitz L, Hoermann P, Trutnau B, Jankauskiene A, Zaloszyc A, Edefonti A Front Pediatr. 2021; 9:666101.

PMID: 34354967 PMC: 8329332. DOI: 10.3389/fped.2021.666101.

Treatment of hyperphosphatemia: the dangers of high PTH levels.

Bacchetta J Pediatr Nephrol. 2019; 35(3):493-500.

PMID: 31696357 DOI: 10.1007/s00467-019-04400-w.

The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis-clinical practice recommendation from the Pediatric Renal Nutrition Taskforce.

McAlister L, Pugh P, Greenbaum L, Haffner D, Rees L, Anderson C Pediatr Nephrol. 2019; 35(3):501-518.

PMID: 31667620 PMC: 6969014. DOI: 10.1007/s00467-019-04370-z.

References

Briese S, Wiesner S, Will J, Lembcke A, Opgen-Rhein B, Nissel R . Arterial and cardiac disease in young adults with childhood-onset end-stage renal disease-impact of calcium and vitamin D therapy. Nephrol Dial Transplant. 2006; 21(7):1906-14. DOI: 10.1093/ndt/gfl098. View

Ziolkowska H, Roszkowska-Blaim M . [Osteoprotegerin and calcium-phosphorus metabolism parameters in children with chronic renal failure]. Przegl Lek. 2006; 63 Suppl 3:68-71. View

Civilibal M, Caliskan S, Adaletli I, Oflaz H, Sever L, Candan C . Coronary artery calcifications in children with end-stage renal disease. Pediatr Nephrol. 2006; 21(10):1426-33. DOI: 10.1007/s00467-006-0159-6. View

. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007; 50(3):471-530. DOI: 10.1053/j.ajkd.2007.06.008. View

Suki W, Zabaneh R, Cangiano J, Reed J, Fischer D, Garrett L . Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients. Kidney Int. 2007; 72(9):1130-7. DOI: 10.1038/sj.ki.5002466. View

Shroff R, Donald A, Hiorns M, Watson A, Feather S, Milford D . Mineral metabolism and vascular damage in children on dialysis. J Am Soc Nephrol. 2007; 18(11):2996-3003. DOI: 10.1681/ASN.2006121397. View

Russo D, Miranda I, Ruocco C, Battaglia Y, Buonanno E, Manzi S . The progression of coronary artery calcification in predialysis patients on calcium carbonate or sevelamer. Kidney Int. 2007; 72(10):1255-61. DOI: 10.1038/sj.ki.5002518. View

Schoppet M, Shroff R, Hofbauer L, Shanahan C . Exploring the biology of vascular calcification in chronic kidney disease: what's circulating?. Kidney Int. 2007; 73(4):384-90. DOI: 10.1038/sj.ki.5002696. View

Shroff R, Egerton M, Bridel M, Shah V, Donald A, Cole T . A bimodal association of vitamin D levels and vascular disease in children on dialysis. J Am Soc Nephrol. 2008; 19(6):1239-46. PMC: 2396936. DOI: 10.1681/ASN.2007090993. View

10.

Litwin M, Wuhl E, Jourdan C, Niemirska A, Schenk J, Jobs K . Evolution of large-vessel arteriopathy in paediatric patients with chronic kidney disease. Nephrol Dial Transplant. 2008; 23(8):2552-7. DOI: 10.1093/ndt/gfn083. View

11.

Ewence A, Bootman M, Roderick H, Skepper J, McCarthy G, Epple M . Calcium phosphate crystals induce cell death in human vascular smooth muscle cells: a potential mechanism in atherosclerotic plaque destabilization. Circ Res. 2008; 103(5):e28-34. DOI: 10.1161/CIRCRESAHA.108.181305. View

12.

Shroff R, McNair R, Figg N, Skepper J, Schurgers L, Gupta A . Dialysis accelerates medial vascular calcification in part by triggering smooth muscle cell apoptosis. Circulation. 2008; 118(17):1748-57. DOI: 10.1161/CIRCULATIONAHA.108.783738. View

13.

Demer L, Sage A, Tintut Y . Nanoscale architecture in atherosclerotic calcification. Arterioscler Thromb Vasc Biol. 2008; 28(11):1882-4. PMC: 4426492. DOI: 10.1161/ATVBAHA.108.175711. View

14.

Goss S, Rafferty P, Prushko J, Gorman E, Taub M, Bogner R . Exploration of intestinal calcium precipitation as a barrier to absorption at high calcium doses. Pharm Res. 2008; 25(12):2760-8. DOI: 10.1007/s11095-008-9640-1. View

15.

Civilibal M, Caliskan S, Kurugoglu S, Candan C, Canpolat N, Sever L . Progression of coronary calcification in pediatric chronic kidney disease stage 5. Pediatr Nephrol. 2008; 24(3):555-63. DOI: 10.1007/s00467-008-1038-0. View

16.

Abrams S, Hicks P, Hawthorne K . Higher serum 25-hydroxyvitamin D levels in school-age children are inconsistently associated with increased calcium absorption. J Clin Endocrinol Metab. 2009; 94(7):2421-7. PMC: 2708956. DOI: 10.1210/jc.2008-2587. View

17.

. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009; (113):S1-130. DOI: 10.1038/ki.2009.188. View

18.

Shroff R, McNair R, Skepper J, Figg N, Schurgers L, Deanfield J . Chronic mineral dysregulation promotes vascular smooth muscle cell adaptation and extracellular matrix calcification. J Am Soc Nephrol. 2009; 21(1):103-12. PMC: 2799273. DOI: 10.1681/ASN.2009060640. View

19.

Rees L, Shroff R . Phosphate binders in CKD: chalking out the differences. Pediatr Nephrol. 2009; 25(3):385-94. DOI: 10.1007/s00467-009-1329-0. View

20.

Emmett M . A comparison of clinically useful phosphorus binders for patients with chronic kidney failure. Kidney Int Suppl. 2004; (90):S25-32. DOI: 10.1111/j.1523-1755.2004.09005.x. View