Calcium salts in the treatment of hyperphosphatemia in hemodialysis patients

Charles R. Nolan, Wajeh Y Qunibi

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Purpose of review: Hyperphosphatemia in patients with end-stage renal disease leads to secondary hyperparathyroidism and renal osteodystrophy, and is independently associated with mortality risk. How hyperphosphatemia increases mortality risk is unknown but it may promote cardiovascular calcification. It is recommended that dialysis patients be treated to maintain normal serum phosphorus. Although calcium-based phosphate binders are cost-effective, their long-term safety has been questioned because of their postulated role in progression of cardiovascular calcification. In this regard, sevelamer hydrochloride has been recommended as an alternative phosphate binder. In this review, we will examine these issues and provide rational guidelines for the use of calcium-based phosphate binders. Recent findings: Results from the calcium acetate Renagel evaluation study indicate that calcium acetate is more effective than sevelamer in controlling serum phosphorus and calcium x phosphorus product in hemodialysis patients. However, in the Treat-to-Goal study dialysis patients treated with sevelamer had less progression of coronary and aortic calcification than patients treated with calcium-containing binders. The mechanism underlying the slower rate of progression of cardiovascular calcification in sevelamer-treated patients remains uncertain but may relate to decreased calcium loading or to dramatic reductions in LDL cholesterol. Summary: At present, evidence incriminating calcium-containing phosphate binders in the progression of cardiovascular calcification in end-stage renal disease remains largely circumstantial. As calcium acetate is more efficacious and cost-effective than sevelamer, it remains an accepted first-line drug. Treatment with sevelamer hydrochloride should be considered for patients with persistent hypercalcemia during calcium-based binder therapy despite appropriate adjustment of vitamin D therapy.

Original languageEnglish (US)
Pages (from-to)373-379
Number of pages7
JournalCurrent Opinion in Nephrology and Hypertension
Volume12
Issue number4
DOIs
StatePublished - Jul 2003

Fingerprint

Hyperphosphatemia
calcium acetate
Renal Dialysis
Salts
Calcium
Phosphorus
Therapeutics
Chronic Kidney Failure
Dialysis
Chronic Kidney Disease-Mineral and Bone Disorder
Costs and Cost Analysis
Secondary Hyperparathyroidism
Mortality
Hypercalcemia
Sevelamer
Serum
Vitamin D
LDL Cholesterol
Phosphates
Guidelines

Keywords

  • Calcium acetate
  • Cardiovascular calcification
  • End-stage renal disease
  • Hyperphosphatemia
  • Phosphate binders
  • Sevelamer hydrochloride

ASJC Scopus subject areas

  • Nephrology
  • Internal Medicine

Cite this

Calcium salts in the treatment of hyperphosphatemia in hemodialysis patients. / Nolan, Charles R.; Qunibi, Wajeh Y.

In: Current Opinion in Nephrology and Hypertension, Vol. 12, No. 4, 07.2003, p. 373-379.

Research output: Contribution to journalArticle

Nolan, Charles R. ; Qunibi, Wajeh Y. / Calcium salts in the treatment of hyperphosphatemia in hemodialysis patients. In: Current Opinion in Nephrology and Hypertension. 2003 ; Vol. 12, No. 4. pp. 373-379.
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