title: Pre-treatment of dairy and breast milk with sevelamer hydrochloride and sevelamer carbonate to reduce phosphate.
abstract: BACKGROUND
  Young children and infants with chronic kidney disease are at increased risk of hyperphosphatemia because of high intake of dairy products. Hyperphosphatemia leads to metastatic calcifications and an increased risk of cardiovascular complications. Sevelamer is an effective phosphate binder, but for children it has important practical disadvantages: it clogs enteral feeding tubes and can cause gastrointestinal complaints. Pre-treatment of dairy products to reduce their phosphate content might solve those problems.
  
  
  METHODS
  Sevelamer hydrochloride and sevelamer carbonate were suspended in various dairy products (cow's milk, breast milk, baby formula, and tube-feeding formula). Each product was tested with varying concentrations of sevelamer. After suspension, each sample was stored for 10 minutes, allowing the sevelamer to precipitate. The supernatant was decanted and analyzed for pH and for phosphate, calcium, magnesium, potassium, sodium, and chloride content.
  
  
  RESULTS
  We observed a significant decrease in the phosphate content of all tested products. With sevelamer hydrochloride, the phosphate reduction was 48% - 91% in the various products, and with sevelamer carbonate, it was 22% - 87%. The highest effectiveness was found in breast milk. A pH increase was found in all products. With sevelamer hydrochloride, a significant increase in chloride occurred. Notably, a significant decrease in calcium content (-75%) was observed in treated breast milk.
  
  
  CONCLUSIONS
  Pretreatment of a variety of dairy products with either sevelamer hydrochloride or sevelamer carbonate effectively reduced their phosphate content and might avoid troublesome ingestion of sevelamer in children. The change in pH with sevelamer hydrochloride was remarkable, reflecting buffering mechanisms. The reduction in the calcium content of breast milk is a potential concern and should be carefully considered and monitored during clinical use of sevelamer.
authors: Department of Pediatric Nephrology,1 and Department of Laboratory Medicine,2 Radboud University Nijmegen Medical Centre, Nijmegen, and Department of Pediatrics,3 Gelre Hospital, Apeldoorn, Netherlands.
authors: Renske
authors: R
authors: Raaijmakers
authors: Lambertus M W
authors: LM
authors: Houkes
authors: Cornelis H
authors: CH
authors: Schröder
authors: Johannes L
authors: JL
authors: Willems
authors: Leo A H
authors: LA
authors: Monnens
mesh_terms: D000284:Administration, Oral; D002675:Child, Preschool; D003611:Dairy Products; D004305:Dose-Response Relationship, Drug; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D007223:Infant; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008895:Milk, Human; D010710:Phosphates / Q000097:blood*; D011073:Polyamines / Q000008:administration & dosage*; D006435:Renal Dialysis / Q000009:adverse effects*; D000069603:Sevelamer; D013607:Tablets; D016896:Treatment Outcome
chemical_list: D010710:Phosphates; D011073:Polyamines; D013607:Tablets; D000069603:Sevelamer
keywords: Hyperphosphatemia; breast milk; infant formula; pediatrics; pharmacotherapy; sevelamer carbonate; sevelamer hydrochloride
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