Calcium alginate, an aluminum-free phosphate binder, in patients on CAPD.
Since dialysis solutions in CAPD are now nearly aluminum free, the only source for elevated aluminum levels are aluminum-containing phosphate binders. Elimination with CAPD is insufficient to prevent aluminum accumulation. Therefore, we investigated a phosphate binder consisting of calcium alginate, a natural polyuronic acid, containing 100 mg calcium/g substance in 14 patients on CAPD over a period of one year. The patients had previously been treated with aluminum-containing phosphate binders for a period of 24.3 +/- 21.3 months. During a period of 3 weeks before changing to the new phosphate binder the mean (+/- SD) serum phosphorus concentration was 1.8 +/- 0.4 mmol/l, while at the end of one year of treatment with calcium alginate the concentration was 1.6 +/- 0.4 mmol/l. In order to lower serum phosphorus to this level, it was necessary to increase the mean (+/- SD) amount of calcium alginate from 6.9 +/- 1.3 g per day at the beginning of the study to 8.3 +/- 2.1 g per day at the end. The mean (+/- SD) serum calcium concentration did not change throughout the study period. Serum levels of alkaline phosphatase, 1.25 (OH)2 vitamin D3, and intact parathyroid hormone did not change as well. The mean (+/- SD) serum aluminum level declined from 36.0 +/- 20 to 14.0 +/- 11.3 micrograms/l after 6 months (p less than 0.001). In conclusion, calcium alginate is a good alternative to aluminum-containing phosphate binders and to phosphate binders on a calcium base as it does not lead to hypercalcemia. It prevents aluminum intoxication and has no serious side effects.
Department of Nephrology, University of Düsseldorf, FRG.
J
J
Passlick
M
M
Wilhelm
T
T
Busch
B
B
Grabensee
F K
FK
Ohnesorge
D000464:Alginates / Q000627:therapeutic use*; D000535:Aluminum / Q000097:blood* / Q000506:poisoning; D002118:Calcium / Q000097:blood; D055598:Chemical Phenomena; D002621:Chemistry; D015314:Dialysis Solutions / Q000627:therapeutic use*; D004341:Drug Evaluation; D005260:Female; D020723:Glucuronic Acid; D006603:Hexuronic Acids; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010710:Phosphates / Q000097:blood
D000464:Alginates; D015314:Dialysis Solutions; D006603:Hexuronic Acids; D010710:Phosphates; D020723:Glucuronic Acid; D000535:Aluminum; D002118:Calcium