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      Long-Term (6 Months) Cross-Over Comparison of Calcium Acetate with Calcium Carbonate as Phosphate Binder

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          Abstract

          A previous short-term study of 10 weeks in 8 patients had shown us that with half the dose of elemental calcium, calcium acetate (CaAc) could control predialysis plasma phosphate (PPO<sub>4</sub>) as well as calcium carbonate (CaCO<sub>3</sub>) but that the incidence of hypercalcemia was not decreased. To better appreciate the value of CaAc in comparison to CaCO<sub>3</sub>, CaAc was given to 28 patients on chronic hemodialysis (6 men, 22 women, age 61 ± 14 years; dialyzate Ca: 1.5 mmol/l) for 6 months to replace CaCO<sub>3</sub> at half the dose of elemental calcium (1,235 ± 521 versus 2,375 ± 1,470 mg/day). Because of gastrointestinal intolerance, CaAc had to be discontinued in 5 patients after 1-5 months. Magnesium hydroxide [Mg(OH)<sub>2</sub>] given in 18 of them in association with CaCO<sub>3</sub> was discontinued and reintroduced in 6 patients in order to keep PPO<sub>4</sub> < 2 mmol/l. Mean dosage of Mg(OH)<sub>2</sub> was 2.09 ± 1.4 g/day with CaCO<sub>3</sub> and 0.9 ± 0.5 with CaAc. Predialysis plasma concentrations of calcium and phosphate were monitored weekly during the 3 months of the control period under CaCO<sub>3</sub> and during the 6-month administration of CaAc. Plasma calcium (PCa) was comparable with the 2 treatments (2.47 ± 0.11 vs. 2.5 ± 0.10 mmol/l), but PPO<sub>4</sub> was significantly lower with CaAc (1.82 ± 0.26 vs. 1.73 ± 0.23 mmol/l). Plasma alkaline phosphatase remained constant (122 ± 66 vs. 122 ± 70; normal < 170 UI/l) as well as plasma intact PTH (121 ± 153 vs. 121 ± 146; normal < 54 pg/ml) and plasma aluminum (0.34 ± 0.23 vs. 0.32 ± 0.20 μmol/l). Hypercalcemia (PCa > 2.7 mmol/l) was present in 11 patients with CaCO<sub>3</sub> and in 16 patients with CaAc, and its incidence did not decrease with CaAc (8.2 vs. 8%). In conclusion, this long-term study confirms that CaAc is a more efficient PO<sub>4 </sub>binder than CaCO<sub>3</sub>. However, its gastrointestinal tolerance seems poorer and the incidence of hypercalcemia is not decreased. The paradox of the unchanged incidence of hypercalcemia with acetate in spite of a reduction by half of the amount of calcium ingested may have two explanations: the very presence of a lower plasma PO<sub>4</sub> concentration (by a physicochemical mechanism) and the possible greater bioavailability of the calcium for absorption when it is given as CaAc.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1993
          1993
          12 December 2008
          : 63
          : 3
          : 258-262
          Affiliations
          Service de Néphrologie, CHU Amiens, France
          Article
          187207 Nephron 1993;63:258–262
          10.1159/000187207
          8446261
          © 1993 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

          Cardiovascular Medicine, Nephrology

          Phosphate binder, Calcium acetate, Calcium carbonate

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