Calcium-containing phosphate binder use associated with accelerated atherosclerotic coronary calcification.
OBJECTIVE
To report parameters and outcomes of phosphorus management in a maintenance hemodialysis patient who experienced atherosclerotic coronary calcification leading to myocardial infarction; to evaluate the role that high calcium intake over 6 years may have played in his coronary artery disease before the dangers of excess calcium intake in phosphorus management were recognized; and to describe an optimized therapeutic approach that provided improved mineral control.


METHODS
Case study.


METHODS
A large outpatient in-center hemodialysis treatment unit.


METHODS
Serum calcium, serum phosphorus, Ca x P product.


RESULTS
The year before his cardiac event, the patient's mean serum calcium was 9.6 mg/dL, mean serum phosphorus was 5.9 mg/dL, and mean Ca x P product was 57 mg2/dL2. Serum calcium peaked at 10.8 mg/dL shortly before his cardiac event. Treatment phases included high-dose calcium acetate (10 g Ca/day), low-dose calcium acetate (4 g Ca/day), low-dose calcium acetate plus low-dose sevelamer hydrochloride (4 g Ca/day plus 2.4 to 4.8 g sevelamer/day), and low-dose calcium acetate plus higher-dose sevelamer hydrochloride (4 g Ca/day plus 4.0 to 12.0 g sevelamer/day). With calcium acetate and sevelamer doses optimized, serum phosphorus levels and Ca x P products continued decreasing, with mean values of 5.99 mg/dL and 50.7 mg2/dL2, respectively, and serum calcium remained stable at a mean of 8.5 mg/dL. The patient has had no further myocardial infarctions.


CONCLUSIONS
This case illustrates how our growing understanding of phosphorus management and the addition of a calcium-free binder to our therapeutic armamentarium have improved phosphorus and calcium balance, reducing the risk of cardiovascular calcification.
Paret
Cindy Lynch
CL
Fresenius Medical Care of Bethlehem, Bethlehem, PA 18017, USA. clp1rd@aol.com
D000085:Acetates / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D002118:Calcium / Q000097:blood / Q000378:metabolism*; D017610:Calcium Compounds; D003324:Coronary Artery Disease / Q000139:chemically induced* / Q000150:complications; D004852:Epoxy Compounds / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D010758:Phosphorus / Q000097:blood / Q000378:metabolism*; D011073:Polyamines; D011095:Polyethylenes / Q000627:therapeutic use; D006435:Renal Dialysis; D000069603:Sevelamer
D000085:Acetates; D017610:Calcium Compounds; D004852:Epoxy Compounds; D011073:Polyamines; D011095:Polyethylenes; D010758:Phosphorus; D000069603:Sevelamer; D002118:Calcium; C120662:calcium acetate