title: Calcium citrate, a nonaluminum-containing phosphate-binding agent for treatment of CRF.
abstract: Calcium citrate was evaluated as a dietary phosphate binder in 81 patients with end-stage renal disease. These patients were grouped as follows: Group 1, 43 patients who were treated with calcium citrate; and Group 2 (the control group), 38 patients who were treated with aluminum-containing compounds. Blood chemistries were measured monthly and medications adjusted to maintain the following levels: serum calcium, greater than 9 mg/dl; serum phosphorus, less than 5.5 mg/dl; and total CO2 content, greater than 22 mmol/liter. At the end of the treatment period, the following serum values were obtained in Groups 1 and 2, respectively: calcium, 9.6 +/- 1.2 mg/dl (mean +/- SD) versus 8.9 +/- 0.8 mg/dl (P less than 0.001); phosphorus 5.5 +/- 1.9 mg/dl versus 7.0 +/- 2.3 mg/dl (P less than 0.005); and calcium-phosphate product, 52 +/- 18 versus 61 +/- 21 (P less than 0.05). Differences in alkaline phosphatase, total CO2 content, and C-terminal parathyroid hormone (C-PTH) values were not statistically significant between the two groups. Fifteen patients in Group 1 were then switched to aluminum-containing compounds and chemistries were compared one month later. During calcium citrate therapy, serum calcium was significantly higher, while C-PTH and serum alkaline phosphatase were significantly reduced. No difference was noted in serum phosphorous and total CO2 content. A questionnaire completed by 17 patients in Group 1 documented excellent patient tolerance to calcium citrate. Hypercalcemia (greater than 10.5 mg/dl) was the only significant complication, but only one patient became symptomatic. We conclude that, as a phosphate binder, calcium citrate is at least as effective as aluminum-containing compounds.
authors.affiliation: Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.
authors.forename: H M
authors.initials: HM
authors.lastname: Cushner
authors.forename: J B
authors.initials: JB
authors.lastname: Copley
authors.forename: J S
authors.initials: JS
authors.lastname: Lindberg
authors.forename: C J
authors.initials: CJ
authors.lastname: Foulks
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000535:Aluminum / Q000009:adverse effects / Q000627:therapeutic use; D002118:Calcium / Q000097:blood; D002951:Citrates / Q000627:therapeutic use*; D019343:Citric Acid; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood*
chemical_list: D002951:Citrates; D010281:Parathyroid Hormone; D010710:Phosphates; D019343:Citric Acid; D000535:Aluminum; D000469:Alkaline Phosphatase; D002118:Calcium