ORAL CALCIUM-CARBONATE AS PHOSPHATE-BINDER IN INFANTS AND CHILDREN WITH CHRONIC-RENAL-FAILURE

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  • 1 January 1986
    • journal article
    • research article
    • Vol. 12  (5-6) , 320-325
Abstract
In view of the known toxicity of aluminum, we studied the effects of CaCO3 as an alternative phosphate binder in 12 chronic renal failure (CRF) children during 152 patient-months. Mean (.+-. SD) serum creatinine concentration rose during that period from 3.7 .+-. 1.8 to 5.1 .+-. 3.0 mg/dl, 8 patients received CaCO3 from the start, and 4 were switched from Al(OH)3 after 2 months of interruption. In addition to CaCO3 (0.1-0.3 gm/kg BW) all patients received NaHCO3, and all but two received 1.alpha.-hydroxyvatamin D3 [1.alpha.(OH)D3] or dihydrotachysterol (DHT). Urine and blood variables were checked every 4-6 weeks and medication dosages were adjusted accordingly, aiming to keep serum Ca at 10.4-10.8 mg/dl, serum Pi at 3.5-5.5 mg/dl, and serum .**GRAPHIC**. above 18 mEq/l. Bone X-rays were obtained every 6-9 months. With treatment, mean serum Ca increased from 8.9 .+-. 0.7 to 10.3 .+-. 0.4 mg/dl (p < 0.01), serum Pi decreased from 6.3 .+-. 0.9 to 4.2 .+-. 0.5 mg/dl (p < 0.01), and the mean Ca .times. P product decreased slightly and insignificantly. Mean serum alkaline phosphatase levels decreased significantly from 486 .+-. 251 to 168 .+-. 28 IU (p < 0.01). Bone X-rays at the end of the study showed either healing of renal osteodystrophy or its prevention. Only one episode of mild hypercalcemia (serum Ca 11.7 mg/dl) was observed in 1 patient, but his Ca .times. P product remained low. No patient exhibited hypercalciuria. In the 4 children who were switched from Al(OH)3 no change in the slopes of the reciprocals of serum creatinine concentration was noted. It is concluded that CaCO3 is an effective and safe substitute to Al(OH)3 as phosphate binder, and that its use in infants and children with CRF results in an improved bone and mineral homeostasis.