title: Calcium-containing phosphate binder use associated with accelerated atherosclerotic coronary calcification.
abstract: 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.
authors.affiliation: Fresenius Medical Care of Bethlehem, Bethlehem, PA 18017, USA. clp1rd@aol.com
authors.forename: Cindy Lynch
authors.initials: CL
authors.lastname: Paret
mesh_terms: 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
chemical_list: D000085:Acetates; D017610:Calcium Compounds; D004852:Epoxy Compounds; D011073:Polyamines; D011095:Polyethylenes; D010758:Phosphorus; D000069603:Sevelamer; D002118:Calcium; C120662:calcium acetate