USE OF CALCIUM-CARBONATE AS A PHOSPHATE BINDER IN DIALYSIS PATIENTS

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  • 1 January 1986
    • journal article
    • research article
    • Vol. 12  (5-6) , 314-319
Abstract
Aluminum-containing phosphate (Al-binders) employed to control serum phosphorus in patients with chronic renal failure can be associated with the development of aluminum toxicity. To obviate the need for Al binders, we examined the effectiveness of CACO3 as a phosphate binder in 31 hemodialysis and 8 CAPD patients followed for 2 months while receiving Al-binders, and then, for 3-14 months while receiving CaCO3 (5.8 .+-. 0.4 g/day). Monthly serum phosphorus averaged 5.4 .+-. 0.2 mg/dl with Al-binders and 5.1 .+-. 0.3 to 5.7 .+-. 0.4 mg/dl with Ca CO3 (P = NS). There were 25.2 episodes of hyperphosphatemia (serum phosphorus > 6.5 mg/dl) per 100 treatment months with Al-binders and 19.2 episodes/100 treatment months with CaCO3 (p = NS). Plasma aluminum levels, 105 .+-. 21.mu.g/l during ingestion of Al-binders, fell to 34 .+-. 11 .mu.g/l after 8 months of therapy with CaCO3 (p < 0.01). Monthly serum Ca averaged 9.5 .+-. 0.1 mg/dl during Al administration and was 8.9 .+-. 0.8 to 10.0 .+-. 0.2 mg/dl with CaCO3 (p = NS). Thirty-four episodes of hypercalcemia (serum Ca > 11.0 mg/dl) occurred in 14 patients ingesting CaCO3 but hypercalcemia did not occur with ingestion of Al-binders, Al-related bone disease was found on bone biopsy in 11 of 13 patients who developed hypercalcemia, compared to only 5 of the 11 biopsied patients who remained normocalcemic (p < 0.01 by .chi.2 analysis). Other side effects included diarrhea in 1 patient and constipation in 3 patients. The CaCO3 was stopped in patients because of asymptomatic hypercalcemia or other side effects and the dose was reduced and Al-binders added in 5 others; 79% remained only on CaCO3. These data suggest that CaCO3 may be safe and effective in the control of serum phosphorus in a large percentage of dialysis patients. The most common complication is hypercalcemia which can often be prevented by a reduction in the dose.