scholarly journals Calcium Acetate versus Calcium Carbonate as Phosphate Binders

Nephron ◽  
1993 ◽  
Vol 63 (1) ◽  
pp. 119-119 ◽  
Author(s):  
T. Ring
Nephron ◽  
1992 ◽  
Vol 60 (4) ◽  
pp. 423-427 ◽  
Author(s):  
F. Caravaca ◽  
I. Santos ◽  
J.J. Cubero ◽  
J.F. Esparrago ◽  
M. Arrobas ◽  
...  

2021 ◽  
pp. 1-10
Author(s):  
Peter A. McCullough

<b><i>Background:</i></b> Cardiovascular disease (CVD) is a major cause of death in patients with chronic kidney disease (CKD) on dialysis. Mortality rates are still unacceptably high even though they have fallen in the past 2 decades. Hyperphosphatemia (elevated serum phosphate levels) is seen in almost all patients with advanced CKD and is by far the largest remaining modifiable contributor to CKD mortality. <b><i>Summary:</i></b> Phosphate retention drives multiple physiological mechanisms linked to increased risk of CVD. Fibroblast growth factor 23 and parathyroid hormone (PTH) levels, both of which have been suggested to have direct pathogenic CV effects, increase in response to phosphate retention. Phosphate, calcium, and PTH levels are linked in a progressively worsening cycle. Maladaptive upregulation of phosphate absorption is also likely to occur further exacerbating hyperphosphatemia. Even higher phosphate levels within the normal range may be a risk factor for vascular calcification and, thus, CV morbidity and mortality. A greater degree of phosphate control is important to reduce the risk of CV morbidity and mortality. Improved phosphate control and regular monitoring of phosphate levels are guideline-recommended, established clinical practices. There are several challenges with the current phosphate management approaches in patients with CKD on dialysis. Dietary restriction of phosphate and thrice-weekly dialysis alone are insufficient/unreliable to reduce phosphate to &#x3c;5.5 mg/dL. Even with the addition of phosphate binders, the only pharmacological treatment currently indicated for hyperphosphatemia, the majority of patients are unable to achieve and maintain phosphate levels &#x3c;5.5 mg/dL (or more normal levels) [PhosLo® gelcaps (calcium acetate): 667 mg (prescribing information), 2011, VELPHORO®: (Sucroferric oxyhydroxide) (prescribing information), 2013, FOSRENAL®: (Lanthanum carbonate) (prescribing information), 2016, AURYXIA®: (Ferric citrate) tablets (prescribing information), 2017, RENVELA®: (Sevelamer carbonate) (prescribing information), 2020, RealWorld dynamix. Dialysis US: Spherix Global Insights, 2019]. Phosphate binders do not target the primary pathway of phosphate absorption (paracellular), have limited binding capacity, and bind nonspecifically [PhosLo® gelcaps (calcium acetate): 667 mg (prescribing information). 2013, VELPHORO®: (Sucroferric oxyhydroxide) (prescribing information), 2013, FOSRENAL®: (Lanthanum carbonate) (prescribing information), 2016, AURYXIA®: (Ferric citrate) tablets (prescribing information), 2017, RENVELA®: (Sevelamer carbonate) (prescribing information) 2020]. <b><i>Key Messages:</i></b> Despite current phosphate management strategies, most patients on dialysis are unable to consistently achieve target phosphate levels, indicating a need for therapeutic innovations [RealWorld dynamix. Dialysis US: Spherix Global Insights, 2019]. Given a growing evidence base that the dominant mechanism of phosphate absorption is the intestinal paracellular pathway, new therapies are investigating ways to reduce phosphate levels by blocking absorption through the paracellular pathway.


2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Atsushi Yaguchi ◽  
Kenji Akahane ◽  
Kumi Tsuchioka ◽  
Saori Yonekubo ◽  
Shota Yamamoto ◽  
...  

Abstract Background Approximately 30% of patients on dialysis received combination therapy for their phosphate binder prescription; however, few studies for combined effects of phosphate binders are reported. For the purpose of evaluating the efficacy of combination therapy, we compared the efficacy of sucroferric oxyhydroxide (PA21) combined with calcium carbonate with that of lanthanum carbonate hydrate, sevelamer hydrochloride, and ferric citrate hydrate combined with calcium carbonate. Methods For in vitro studies, calcium carbonate and the other phosphate binders alone or in combination were stirred in phosphate solution at pH 2–8 for 2 h. After centrifuging the suspension, the phosphorus level in the supernatant was determined. For in vivo studies, rats were orally administered calcium carbonate and the other phosphate binders (except for sevelamer hydrochloride) alone or in combination, followed by oral administration of phosphate solution adjusted to pH 2 or 7. Serum samples were collected from the rats at predetermined timepoints and the serum phosphorus levels were determined and analyzed using a two-way analysis of variance. Results In the in vitro study, the measured phosphate-binding capacity of combining sevelamer hydrochloride, PA21, and lanthanum carbonate hydrate with calcium carbonate was approximately equal to or greater than the theoretical values under most conditions. Furthermore, these combined effects were insensitive to pH in that order. The measured phosphate-binding capacity of ferric citrate hydrate combined with calcium carbonate was smaller than the theoretical values, and the combination did not exhibit efficacy under any of the tested conditions. In the in vivo study, the combined effect of PA21 and calcium carbonate at both pH values and that of lanthanum carbonate hydrate and calcium carbonate at pH 2 were additive. In contrast, the combined effect of lanthanum carbonate hydrate and calcium carbonate at pH 7 and that of ferric citrate hydrate and calcium carbonate at pH 2 were antagonistic. Conclusions These results suggest that coadministration of PA21 and calcium carbonate showed good and relatively stable efficacy throughout the range of the gastrointestinal pH and that combining lanthanum carbonate hydrate and ferric citrate hydrate with calcium carbonate may not produce the expected efficacy under certain conditions.


2018 ◽  
Vol 44 (1) ◽  
pp. 8
Author(s):  
Diana Vergnano ◽  
Emanuela Valle ◽  
Natascia Bruni ◽  
Rita Rizzi ◽  
Mauro Bigliati ◽  
...  

Background: Chronic kidney disease (CKD) is a very common pathology in cats, especially in the geriatric age. A proper renal diet is considered the current standard of care to enhance patients’ long-term survival and quality of life. However, when diet alone is not sufficient, it is necessary to supplement it with specific substances: these are phosphate binders and alkalinizing agents. The aim of this study was to evaluate the effectiveness of a feed supplement containing calcium carbonate, calcium lactate gluconate, chitosan and sodium bicarbonate in controlling hyperphosphatemia and metabolic acidosis in cats with severe CKD (IRIS, International Renal Interest Society, stage 3 and 4).Materials, Methods & Results: 10 cats (median BW 4.00 (3.20; 5.70) Kg, BCS 3/5 (2.25; 3.75), 11 (8.25;12.00) years) fed with a balanced renal diet were included in the study. To be enrolled in the study cats had to be affected by CKD in stages 3 or 4 and show hyperphosphatemia. Treatment consisted in oral administration of the product (Renal, Candioli Pharma) at 0.2 g/kg/day mixed with the food for 60 days. The animals were evaluated at the beginning of the study and at 15, 30, 60 days (T0, T15, T30, T60) for: clinical condition, BW, BCS, blood pressure and for routinely hematochemical, biochemical and urinary parameters. Owners were asked to assess appetite of the cat, palatability of the supplement, presence of vomit and/or diarrhoea, general health and vitality. All statistical analyses were performed using SAS software. After checking normality data were analyzed using Kruskal-Wallis and Wilcoxon tests. Results are expressed as median (interquartile range). For the parameters P (P < 0.0001), iCa (P = 0.0008) and HCO3 (P = 0.0002) there were statistically significant differences among times of supplementation (T0, T15, T30, T60). Statistically significant reduction of serum phosphorus concentration was obtained through the study (reduction of 59% at T60 vs T0). Also a statistically significant increase of bicarbonate was seen (7% from T0 to T60). At T60 was also recorded an increase of ionized calcium level, which however was in normal range. For the other laboratory parameters, no statistical difference was recorded. All the owners reported a good palatability of the product. The decrease of vomit and diarrhea episodes and the increase of the appetite reported were statistically significant (P < 0.05).Discussion: The restriction of available dietary phosphorus is now recognised as one of the major contributors in slowing the disease progression and improving survival rates. Phosphate binders are able to absorb phosphate (P) in the intestine, forming insoluble products that are eliminated with the faeces, thus decreasing serum phosphate levels. The phosphate binders contained in the product tested in the present trial were chitosan, calcium lactate gluconate and calcium carbonate. During the study P decreased significantly from T0 to T60, reaching the target post-treatment plasma P concentration for IRIS stage 3 after 30 days. Another important recommendation for CKD treatment is to use alkalinisation therapy if metabolic acidosis is present. The feed supplement tested in this study also contained sodium bicarbonate. In our study, 90% of the patients at the inclusion examination had metabolic acidosis. At the end of the study, the median blood bicarbonate concentration was in the normal range, thus reaching the IRIS treatment target. The feed supplement tested was therefore effective in reducing blood phosphate levels and in increasing blood bicarbonate levels, thus improving the cats’ clinical conditions for the duration of the study without any adverse effect.


1995 ◽  
Vol 10 (12) ◽  
pp. 2321-2324 ◽  
Author(s):  
M. J. A. Janssen ◽  
A. van der Kuy ◽  
P. M. ter Wee ◽  
W. -P. L. van Boven

1991 ◽  
Vol 6 (3) ◽  
pp. 170-175 ◽  
Author(s):  
K. Schaefer ◽  
J. Scheer ◽  
G. Asmus ◽  
E. Umlauf ◽  
J. Hagemann ◽  
...  

Nephron ◽  
1992 ◽  
Vol 60 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Ph. Morinière ◽  
M. Djerad ◽  
B. Boudailliez ◽  
N. El Esper ◽  
F. Boitte ◽  
...  

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