title: Metabolic and skeletal effects of low and high doses of calcium acetate in patients with preterminal chronic renal failure.
abstract: 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.
authors.affiliation: 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
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Phelps
authors.forename: Marc
authors.initials: M
authors.lastname: Stern
authors.forename: Alice
authors.initials: A
authors.lastname: Slingerland
authors.forename: Mahin
authors.initials: M
authors.lastname: Heravi
authors.forename: David S
authors.initials: DS
authors.lastname: Strogatz
authors.forename: Syed S
authors.initials: SS
authors.lastname: Haqqie
mesh_terms: 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
chemical_list: D000085:Acetates; D017610:Calcium Compounds; D010281:Parathyroid Hormone; D010758:Phosphorus; D002117:Calcitriol; D002118:Calcium; C120662:calcium acetate