Metabolic and skeletal effects of low and high doses of calcium acetate in patients with preterminal chronic renal failure.
BACKGROUND
Secondary hyperparathyroidism commonly evolves, as the glomerular filtration rate falls. The metabolic and skeletal effects of a possible remedy, calcium acetate, have not been studied in patients with preterminal chronic renal failure.


METHODS
Men with a mean creatinine clearance of approximately 30 ml/min took calcium acetate for 24 weeks at doses which provided 507 or 1,521 mg calcium/day with meals. Metabolic determinations were made at intervals of 4-8 weeks, and the bone mineral density (BMD) was measured at the beginning and at the end of the trial.


RESULTS
The low-dose regimen produced no metabolic or skeletal effect. In subjects prescribed the high-dose regimen, the 24-hour urine phosphorus excretion fell from 0.53 mg/mg creatinine to values ranging from 0.34 to 0.41 mg/mg creatinine. The theoretical phosphorus threshold concentration rose by a maximum of 38.6%, and the serum phosphorus concentration did not change. The mean serum calcium concentration rose by a maximum of 7.2%. The mean fractional changes in parathyroid hormone and 1,25-dihydroxyvitamin D concentrations ranged from -27.0 to -39.6% and from -5.0 to -20.3%, respectively. The BMD increased at L1, L3, and L4.


CONCLUSIONS
Calcium acetate prescribed to deliver 1,521 mg calcium/day with meals reduced parathyroid hormone and 1,25-dihydroxyvitamin D concentrations and increased lumbar BMD in men with preterminal chronic renal failure.
Phelps
Kenneth R
KR
Samuel S. Stratton Department of Veterans Affairs Medical Center, Albany Medical College, and State University of New York School of Public Health, Albany, N.Y. 12208, USA. Kenneth.Phelps@med.va.gov
Stern
Marc
M
Slingerland
Alice
A
Heravi
Mahin
M
Strogatz
David S
DS
Haqqie
Syed S
SS
D000085:Acetates / Q000008:administration & dosage*; D000368:Aged; D015519:Bone Density / Q000187:drug effects*; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D017610:Calcium Compounds; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood / Q000652:urine; D011446:Prospective Studies
D000085:Acetates; D017610:Calcium Compounds; D010281:Parathyroid Hormone; D010758:Phosphorus; D002117:Calcitriol; D002118:Calcium; C120662:calcium acetate