High-dose calcium carbonate with stepwise reduction in dialysate calcium concentration: effective phosphate control and aluminium avoidance in haemodialysis patients.
To reduce potentially toxic aluminium exposure, the phosphate binding agent aluminium hydroxide was replaced by high-dose oral calcium carbonate in 15 haemodialysis patients. Stepwise reduction in dialysate calcium concentration (from 1.75 to 1.35 mmol/l and then to 1.05 mmol/l) was made when necessitated by hypercalcaemia. After 6 months, the mean daily dose of calcium carbonate was 62 mmol (range 25-150 mmol). This dose maintained good control of plasma phosphate (baseline, 1.34 +/- 0.32 mmol/l (mean +/- SD); 12 weeks, 1.30 +/- 0.22 mmol/l; 24 weeks, 1.51 +/- 0.31 mmol/l). Calcium x phosphate product did not rise significantly (baseline, 3.41; 12 weeks, 3.44; 24 weeks, 4.02). Apart from a transient early increase, ionised calcium did not change significantly (baseline, 1.23 +/- 0.10 mmol/l; 12 weeks, 1.24 +/- 0.10 mmol/l). Intact (1-84) parathyroid hormone concentration decreased from 241 pg/ml to 116 pg/ml (median values, P less than 0.05) after 12 weeks. This simple and well-tolerated regimen almost completely eliminated oral aluminium exposure, effectively controlled plasma phosphate and calcium concentrations, and reduced hyperparathyroidism.
Sawyer
N
N
Department of Nephrology, London Hospital, UK.
Noonan
K
K
Altmann
P
P
Marsh
F
F
Cunningham
J
J
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000535:Aluminum / Q000097:blood*; D000536:Aluminum Hydroxide / Q000008:administration & dosage; D002118:Calcium / Q000097:blood*; D002119:Calcium Carbonate / Q000008:administration & dosage*; D015314:Dialysis Solutions / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015312:Hemodialysis Solutions / Q000008:administration & dosage*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood*; D006435:Renal Dialysis
D015314:Dialysis Solutions; D015312:Hemodialysis Solutions; D010281:Parathyroid Hormone; D010710:Phosphates; D000536:Aluminum Hydroxide; D000535:Aluminum; D002119:Calcium Carbonate; D002118:Calcium