title: Calcium Acetate/Magnesium Carbonate and Cardiovascular Risk Factors in Chronic Hemodialysis Patients.
abstract: OBJECTIVE
  Calcium acetate/magnesium carbonate (CaMg) is a recent phosphate binder that has been shown to have protective cardiovascular (CV) effects in animal models. The aim of this study was to evaluate the relationship between CaMg therapy and CV risk markers like pulse pressure (PP), left ventricular mass index (LVMI) and valvular calcifications compared to sevelamer or no phosphate binder (NPB) therapy in chronic hemodialysis (HD) patients.
  
  
  METHODS
  We performed a 48-month prospective study in 138 HD patients under hemodiafiltration with a dialysate Mg concentration of 0.5 mmol/l. Patients underwent treatment with CaMg or sevelamer for at least 36 months or NPB therapy. Demographic, clinical, biochemical and echocardiographic parameters were evaluated at baseline and after a 48-month period.
  
  
  RESULTS
  At the end of the study, patients who had taken CaMg showed a significant reduction in PP (p < 0.001), LVMI (p = 0.003), aortic (p = 0.004) and mitral valve calcifications (p = 0.03) compared with NPB patients. Patients under CaMg showed a significant reduction of PP (p < 0.001), LVMI (p = 0.01) and aortic valve calcifications (p = 0.02) compared to sevelamer patients. In a multivariable analysis, CaMg therapy was negatively associated with progression of LVMI (p = 0.02) and aortic valve calcifications (p = 0.01). Patients under CaMg showed higher serum Mg levels (0.93 ± 0.14 mmol/l) compared to patients under sevelamer (0.87 ± 0.13) or NPB patients (0.82 ± 0.12; p < 0.001).
  
  
  CONCLUSIONS
  In prevalent HD patients, the use of CaMg over 48 months was associated with a reduction of PP and LVMI and with a stabilization of aortic valve calcifications. These protective and promising results of this new phosphate binder need to be confirmed in randomized controlled studies.
authors.affiliation: Nephrocare - Vila Franca de Xira - Dialysis Unit, Vila Franca de Xira, Portugal.
authors.forename: Patrícia João
authors.initials: PJ
authors.lastname: Matias
authors.forename: Cristina
authors.initials: C
authors.lastname: Jorge
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.forename: Ivo
authors.initials: I
authors.lastname: Laranjinha
authors.forename: David
authors.initials: D
authors.lastname: Navarro
authors.forename: Marco
authors.initials: M
authors.lastname: Mendes
authors.forename: Tiago
authors.initials: T
authors.lastname: Amaral
authors.forename: Carina
authors.initials: C
authors.lastname: Ferreira
authors.forename: Inês
authors.initials: I
authors.lastname: Aires
authors.forename: Célia
authors.initials: C
authors.lastname: Gil
authors.forename: Stefano
authors.initials: S
authors.lastname: Stuard
authors.forename: Aníbal
authors.initials: A
authors.lastname: Ferreira
mesh_terms: D000085:Acetates / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D017610:Calcium Compounds / Q000008:administration & dosage; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006801:Humans; D008274:Magnesium / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors
chemical_list: D000085:Acetates; D017610:Calcium Compounds; C005479:magnesium carbonate; D008274:Magnesium; C120662:calcium acetate