Calcium acetate versus calcium carbonate as phosphate-binding agents in chronic haemodialysis

摘要: Hyperphosphataemia plays a key role in the pathogenesis of renal osteodystrophy, and phosphate-binding agents are required many chronic dialysis patients. Aluminium hydroxide calcium carbonate well-established phosphate binders, but their use is associated with toxicity or poor efficacy. Calcium acetate known to be potent binder, has recently been used successfully In this randomized cross-over trial 31 haemodialysis patients, equimolar doses were administered for 6 weeks each. Compliance was estimated from tablet counts, biochemical parameters measured at end each treatment period. Of patients 23 completed both arms; remainder, three withdrew due adverse symptoms, hypercalcaemia necessitated withdrawal two, died. Non-compliance significantly higher (18.3% tablets not taken) than (8.7%). Serum lower after (1.51 mmol/l) (1.80), as Ca x PO4 product (3.59 vs 4.18 respectively) PTH (17.8 25.4 pmol/l respectively). therapy (2.40 2.32 mmol/l). No significant difference found sodium, potassium, bicarbonate, urea, creatinine, haemoglobin. This study confirms that hyperphosphataemia more effective carbonate. For first time an beneficial effect on secondary hyperparathyroidism also demonstrated. Patient tolerability considerably poorer, probably part formulation bulkiness, well possible direct gastrointestinal effects salt.