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      Calcium Acetate versus Calcium Carbonate as Phosphate Binders in Hemodialysis Patients

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          Abstract

          We conducted a randomized unblinded parallel clinical trial to compare the effectiveness, side effects and tolerance between calcium acetate (CA) and calcium carbonate (CC) in 80 stable chronic hemodialysis patients selected on the basis of their acceptable control of serum phosphorus (P) levels with aluminum hydroxide (AH). All patients were dialyzed against the same calcium dialyzate (1.62 mmol/l). The serum analytical tests included: calcium corrected to total protein, P, PTH (intact molecule) and bicarbonate. The study was divided into the following periods: P0: baseline measurements; P1: washout (winthdrawal of AH for 15 days); P2: random allocation to CA and CC treatment at doses equivalent to 75 mEq of elemental calcium, stratified according to previous doses of AH (2 months); P3: adjustment of doses until control P (2 months). CA was poorly tolerated in 7 patients and CC in 2 (NS). The changes in serum P levels between P0 and P2 periods were lower in the CA group (1.73 ± 0.25 vs. 1.80 ± 0.50 mmol/l; p = 0.26) than in the CC group (1.77 ± 0.35 vs. 1.93 ± 0.48 mmol/l; p = 0.03, paired t test). Serum calcium was hardly modified by CA (2.42 ± 0.20 vs. 2.47 ± 0.17 mmol/l; NS) while in the CC group, it rose significantly (2.40 ± 0.12 vs. 2.55 ± 0.22 mmol/l; p = 0.0004). There were no differences in the control of PTH or bicarbonate. At the P3 period, patients on CC treatment needed higher doses of elemental calcium to control P than the CA group (99.4 ± 31 vs. 83 ± 27 mEq; p = 0.01), and at these doses, hypercalcemia ( > 2.86 mmol/l) was more frequent in the CC group (30.5 vs. 16%; NS). We conclude that CA is slightly more effective and safer than CC, albeit less well tolerated.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1992
          1992
          11 December 2008
          : 60
          : 4
          : 423-427
          Affiliations
          aNephrology Division and bPharmacy Service, Hospital Regional Infanta Cristina, Badajoz, Spain
          Article
          186802 Nephron 1992;60:423–427
          10.1159/000186802
          1584317
          © 1992 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 5
          Categories
          Original Paper

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