Elemental Calcium Intake Associated with Calcium Acetate/calcium Carbonate in the Treatment of Hyperphosphatemia

Overview

Journal Drugs Context

Specialty Pharmacology

Date 2017 Feb 10

PMID 28182142

Citations 1

Authors

Rosamund J Wilson

J Brian Copley

Affiliations

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Abstract

Background: Calcium-based and non-calcium-based phosphate binders have similar efficacy in the treatment of hyperphosphatemia; however, calcium-based binders may be associated with hypercalcemia, vascular calcification, and adynamic bone disease.

Scope: A analysis was carried out of data from a 16-week, Phase IV study of patients with end-stage renal disease (ESRD) who switched to lanthanum carbonate monotherapy from baseline calcium acetate/calcium carbonate monotherapy. Of the intent-to-treat population (N=2520), 752 patients with recorded dose data for calcium acetate (n=551)/calcium carbonate (n=201) at baseline and lanthanum carbonate at week 16 were studied. Elemental calcium intake, serum phosphate, corrected serum calcium, and serum intact parathyroid hormone levels were analyzed.

Findings: Of the 551 patients with calcium acetate dose data, 271 (49.2%) had an elemental calcium intake of at least 1.5 g/day at baseline, and 142 (25.8%) had an intake of at least 2.0 g/day. Mean (95% confidence interval [CI]) serum phosphate levels were 6.1 (5.89, 6.21) mg/dL at baseline and 6.2 (6.04, 6.38) mg/dL at 16 weeks; mean (95% CI) corrected serum calcium levels were 9.3 (9.16, 9.44) mg/dL and 9.2 (9.06, 9.34) mg/dL, respectively. Of the 201 patients with calcium carbonate dose data, 117 (58.2%) had an elemental calcium intake of at least 1.5 g/day, and 76 (37.8%) had an intake of at least 2.0 g/day. Mean (95% CI) serum phosphate levels were 5.8 (5.52, 6.06) mg/dL at baseline and 5.8 (5.53, 6.05) mg/dL at week 16; mean (95% CI) corrected serum calcium levels were 9.7 (9.15, 10.25) mg/dL and 9.2 (9.06, 9.34) mg/dL, respectively.

Conclusion: Calcium acetate/calcium carbonate phosphate binders, taken to control serum phosphate levels, may result in high levels of elemental calcium intake. This may lead to complications related to calcium balance.

Citing Articles

Prevalence and risk factors for hypercalcemia among non-dialysis patients with chronic kidney disease-mineral and bone disorder.

Seng J, Tan Y, Lim R, Ng H, Lee P, Wong J Int Urol Nephrol. 2018; 50(10):1871-1877.

PMID: 29882003 DOI: 10.1007/s11255-018-1906-x.

References

Moe S, Chertow G . The case against calcium-based phosphate binders. Clin J Am Soc Nephrol. 2007; 1(4):697-703. DOI: 10.2215/CJN.00560206. View

Fernandez-Martin J, Carrero J, Benedik M, Bos W, Covic A, Ferreira A . COSMOS: the dialysis scenario of CKD-MBD in Europe. Nephrol Dial Transplant. 2012; 28(7):1922-35. DOI: 10.1093/ndt/gfs418. View

Budoff M, Rader D, Reilly M, Mohler 3rd E, Lash J, Yang W . Relationship of estimated GFR and coronary artery calcification in the CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis. 2011; 58(4):519-26. PMC: 3183168. DOI: 10.1053/j.ajkd.2011.04.024. View

Block G, Spiegel D, Ehrlich J, Mehta R, Lindbergh J, Dreisbach A . Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int. 2005; 68(4):1815-24. DOI: 10.1111/j.1523-1755.2005.00600.x. View

Hruska K, Mathew S, Lund R, Qiu P, Pratt R . Hyperphosphatemia of chronic kidney disease. Kidney Int. 2008; 74(2):148-57. PMC: 2735026. DOI: 10.1038/ki.2008.130. View

. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42(4 Suppl 3):S1-201. View

Vemuri N, Michelis M, Matalon A . Conversion to lanthanum carbonate monotherapy effectively controls serum phosphorus with a reduced tablet burden: a multicenter open-label study. BMC Nephrol. 2011; 12:49. PMC: 3197476. DOI: 10.1186/1471-2369-12-49. View

Qunibi W, Moustafa M, Muenz L, He D, Kessler P, Diaz-Buxo J . A 1-year randomized trial of calcium acetate versus sevelamer on progression of coronary artery calcification in hemodialysis patients with comparable lipid control: the Calcium Acetate Renagel Evaluation-2 (CARE-2) study. Am J Kidney Dis. 2008; 51(6):952-65. DOI: 10.1053/j.ajkd.2008.02.298. View

Taal M, Masud T, Green D, Cassidy M . Risk factors for reduced bone density in haemodialysis patients. Nephrol Dial Transplant. 1999; 14(8):1922-8. DOI: 10.1093/ndt/14.8.1922. View

10.

Hill K, Martin B, Wastney M, McCabe G, Moe S, Weaver C . Oral calcium carbonate affects calcium but not phosphorus balance in stage 3-4 chronic kidney disease. Kidney Int. 2012; 83(5):959-66. PMC: 4292921. DOI: 10.1038/ki.2012.403. View

11.

Moe S, Chen N . Mechanisms of vascular calcification in chronic kidney disease. J Am Soc Nephrol. 2007; 19(2):213-6. DOI: 10.1681/ASN.2007080854. View

12.

Ganesh S, Stack A, Levin N, Hulbert-Shearon T, Port F . Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001; 12(10):2131-2138. DOI: 10.1681/ASN.V12102131. View

13.

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

14.

Hutchison A, Maes B, Vanwalleghem J, Asmus G, Mohamed E, Schmieder R . Efficacy, tolerability, and safety of lanthanum carbonate in hyperphosphatemia: a 6-month, randomized, comparative trial versus calcium carbonate. Nephron Clin Pract. 2005; 100(1):c8-19. DOI: 10.1159/000084653. View

15.

Braun J, Asmus H, Holzer H, Brunkhorst R, Krause R, Schulz W . Long-term comparison of a calcium-free phosphate binder and calcium carbonate--phosphorus metabolism and cardiovascular calcification. Clin Nephrol. 2004; 62(2):104-15. DOI: 10.5414/cnp62104. View

16.

Albaaj F, Hutchison A . Hyperphosphataemia in renal failure: causes, consequences and current management. Drugs. 2003; 63(6):577-96. DOI: 10.2165/00003495-200363060-00005. View

17.

Raggi P, Vukicevic S, Moyses R, Wesseling K, Spiegel D . Ten-year experience with sevelamer and calcium salts as phosphate binders. Clin J Am Soc Nephrol. 2010; 5 Suppl 1:S31-40. DOI: 10.2215/CJN.05880809. View

18.

Navaneethan S, Palmer S, Craig J, Elder G, Strippoli G . Benefits and harms of phosphate binders in CKD: a systematic review of randomized controlled trials. Am J Kidney Dis. 2009; 54(4):619-37. DOI: 10.1053/j.ajkd.2009.06.004. View

19.

Young E, Albert J, Satayathum S, Goodkin D, Pisoni R, Akiba T . Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2005; 67(3):1179-87. DOI: 10.1111/j.1523-1755.2005.00185.x. View

20.

Menon V, Greene T, Pereira A, Wang X, Beck G, Kusek J . Relationship of phosphorus and calcium-phosphorus product with mortality in CKD. Am J Kidney Dis. 2005; 46(3):455-63. DOI: 10.1053/j.ajkd.2005.05.025. View