title: Effects of phosphate binders in moderate CKD.
abstract: Some propose using phosphate binders in the CKD population given the association between higher levels of phosphorus and mortality, but their safety and efficacy in this population are not well understood. Here, we aimed to determine the effects of phosphate binders on parameters of mineral metabolism and vascular calcification among patients with moderate to advanced CKD. We randomly assigned 148 patients with estimated GFR=20-45 ml/min per 1.73 m(2) to calcium acetate, lanthanum carbonate, sevelamer carbonate, or placebo. The primary endpoint was change in mean serum phosphorus from baseline to the average of months 3, 6, and 9. Serum phosphorus decreased from a baseline mean of 4.2 mg/dl in both active and placebo arms to 3.9 mg/dl with active therapy and 4.1 mg/dl with placebo (P=0.03). Phosphate binders, but not placebo, decreased mean 24-hour urine phosphorus by 22%. Median serum intact parathyroid hormone remained stable with active therapy and increased with placebo (P=0.002). Active therapy did not significantly affect plasma C-terminal fibroblast growth factor 23 levels. Active therapy did, however, significantly increase calcification of the coronary arteries and abdominal aorta (coronary: median increases of 18.1% versus 0.6%, P=0.05; abdominal aorta: median increases of 15.4% versus 3.4%, P=0.03). In conclusion, phosphate binders significantly lower serum and urinary phosphorus and attenuate progression of secondary hyperparathyroidism among patients with CKD who have normal or near-normal levels of serum phosphorus; however, they also promote the progression of vascular calcification. The safety and efficacy of phosphate binders in CKD remain uncertain.
authors: Denver Nephrology, 130 Rampart Way, Suite 300b, Denver, CO 80230, USA. gablock@denverneph.net
authors: Geoffrey A
authors: GA
authors: Block
authors: David C
authors: DC
authors: Wheeler
authors: Martha S
authors: MS
authors: Persky
authors: Bryan
authors: B
authors: Kestenbaum
authors: Markus
authors: M
authors: Ketteler
authors: David M
authors: DM
authors: Spiegel
authors: Matthew A
authors: MA
authors: Allison
authors: John
authors: J
authors: Asplin
authors: Gerard
authors: G
authors: Smits
authors: Andrew N
authors: AN
authors: Hoofnagle
authors: Laura
authors: L
authors: Kooienga
authors: Ravi
authors: R
authors: Thadhani
authors: Michael
authors: M
authors: Mannstadt
authors: Myles
authors: M
authors: Wolf
authors: Glenn M
authors: GM
authors: Chertow
mesh_terms: D000085:Acetates / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects; D017610:Calcium Compounds / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use*; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D006801:Humans; D054559:Hyperphosphatemia / Q000209:etiology / Q000517:prevention & control*; D007811:Lanthanum / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood / Q000652:urine; D010865:Pilot Projects; D011073:Polyamines / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D000069603:Sevelamer; D061205:Vascular Calcification / Q000139:chemically induced
chemical_list: D000085:Acetates; D017610:Calcium Compounds; D002614:Chelating Agents; D010281:Parathyroid Hormone; D010710:Phosphates; D011073:Polyamines; C119467:lanthanum carbonate; D005346:Fibroblast Growth Factors; D007811:Lanthanum; D000089703:Fibroblast Growth Factor-23; D000069603:Sevelamer; C120662:calcium acetate