Successful Control of Hyperparathyroidism in Patients on Continuous Ambulatory Peritoneal Dialysis Using Magnesium Carbonate and Calcium Carbonate as Phosphate Binders

Nephron ◽  
1993 ◽  
Vol 63 (4) ◽  
pp. 379-383 ◽  
Author(s):  
Victor Parsons ◽  
Dianne Baldwin ◽  
Caje Moniz ◽  
Joanne Marsden ◽  
Elizabeth Ball ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Calcium Carbonate ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Magnesium Carbonate ◽  
Phosphate Binders ◽  
Successful Control

scholarly journals MgCaCO3Versus CaCO3in Peritoneal Dialysis Patients – a Cross-over Pilot Trial

2015 ◽  
Vol 35 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Baigalmaa Evsanaa ◽  
Irene Liu ◽  
Babak Aliazardeh ◽  
Sara Mahdavi ◽  
Gursarn Bajwa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Calcium Carbonate ◽  
Pilot Study ◽  
Serum Magnesium ◽  
Pilot Trial ◽  
Magnesium Carbonate ◽  
Serum Phosphate ◽  
Phosphate Binders ◽  
Serum Phosphate Level ◽  
Calcium Magnesium

BackgroundDespite adverse effects such as constipation, vascular calcification, and hypercalcemia, calcium-based salts are relatively affordable and effective phosphate binders that remain in widespread use in the dialysis population. We conducted a pilot study examining whether the use of a combined magnesium/calcium-based binder was as effective as calcium carbonate at lowering serum phosphate levels in peritoneal dialysis (PD) patients.MethodsThis was a cross-over, investigator-masked pilot study in which prevalent PD patients received calcium carbonate alone (200 mg calcium per tablet) or calcium magnesium carbonate (100 mg calcium, 85 mg magnesium per tablet). Primary outcome was serum phosphate level at 3 months. Analysis was as per protocol.ResultsTwenty patients were recruited, 17 completed the study. Mean starting dose was 11.35 ± 7.04 pills per day of MgCaCO3and 9.00 ± 4.97 pills per day of CaCO3. Mean phosphate levels fell from 2.13 mmol/L to 2.01 mmol/L (95% confidence interval (CI): 1.76 – 2.30, p = 0.361) in the MgCaCO3group, and 1.81 mmol/L (95% CI: 1.56 – 2.0, p = 0.026) in the CaCO3alone group. Six (35%) patients taking MgCaCO3and 9 (54%) taking CaCO3alone achieved Kidney Disease Outcomes Quality Initiative (KDOQI) serum phosphate targets at 3 months. Diarrhea developed in 9 patients taking MgCaCO3and 3 taking CaCO3. Serum magnesium exceeded 1.4 mmol/L in 5 patients taking MgCaCO3while serum calcium exceeded 2.65 mmol/L in 3 patients receiving CaCO3. When compared to the initial dose, the prescribed dose at 3 months was reduced by 44% (to 6.41 tablets/day) in the MgCaCO3group and by 8% (to 8.24 pills per day) in the CaCO3alone group.ConclusionCompared with CaCO3alone, the preparation and dose of MgCaCO3used in this pilot study was no better at lowering serum phosphate levels in PD patients, and was associated with more dose-limiting side effects.

Risk Factors for Hyperaluminemia in Continuous Ambulatory Peritoneal Dialysis

1986 ◽  
Vol 6 (4) ◽  
pp. 188-191 ◽  
Author(s):  
Robert A. Mactier ◽  
Karl D. Nolph ◽  
Ramesh Khanna ◽  
Zbylut Twardowski
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Aluminum Toxicity ◽  
Elevated Serum ◽  
Phosphate Binders ◽  
Untreated Water ◽  
Stage Renal Disease ◽  
End Stage

The authors evaluated risk factors for hyperaluminemia and aluminum toxicity in 51 CAPD patients, who received aluminum-containing phosphate binders. Serum aluminum correlated with total intake of elemental aluminum after starting CAPD (p = 0.001), with aluminum intake in the previous six months (p = 0.001), with duration of CAPD (p = 0.003), and with serum phosphate (p = 0.05). Eight patients had elevated serum aluminum, but only one had clincial evidence of aluminum toxicity (he had been on hemodialysis with untreated water until he was changed to CAPD 30 months before the study). Although the incidence of clinical aluminum toxicity appears to be low, we conclude that the aluminum intake from aluminum-containing phosphate binders is a major factor in the evolution of hyperaluminemia and, potentially, aluminum toxicity in CAPD patients. We believe that alternative effective, phosphate binders are much needed. It has been shown that tissue accumulation of aluminum in brain, bone and blood in uremic patients causes encephalopathy (I. 2), osteomalacia (3, 4), and anemia (5, 6). Clinically aluminum toxicity has been observed mainly in hemodialysis patients (1–6), although it has been reported in few cases before dialysis (7–9) and in those on continuous ambulatory peritoneal dialysis (10. II). The major cause of aluminum toxicity during hemodialysis has been transfer of aluminum from untreated water in the dialysate (1–5); this mechanism has tended to obscure the contribution of other factors, such as diet and drugs. Peritoneal dialysate contains a low concentration of aluminum (less than 15 μg/L) and there is a net removal of aluminum in the dialysate in those with serum aluminum levels within the reference range for dialysed uremics (11–13). Serial aluminum levels in CAPD patients not receiving aluminum -containing phosphate binders (ACPB) showed no significant change during a two-year follow-up (12, 14); this suggests that aluminum removal in the dialysate compensates for the failure of the kidney to excrete absorbed dietary aluminum in end-stage renal disease. Since the combination of CAPD and diet appears to have minimal influence on serum aluminum, this study was done to identify those factors which determine serum aluminum levels in CAPD patients, receiving aluminum-containing phosphate binders.

Renal Osteodystrophy in Patients on Continuous Ambulatory Peritoneal Dialysis: A Five Year Study

1987 ◽  
Vol 7 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Rabihur Rahman ◽  
Alexander Heaton ◽  
Timothy H.J. Goodship ◽  
R. Stuart ◽  
C. Rodger ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Renal Osteodystrophy ◽  
Good Control ◽  
Normal Serum ◽  
Serum Phosphate ◽  
Phosphate Binders ◽  
Total Calcium ◽  
Serum Parathyroid Hormone ◽  
Serum Aluminium

The clinical, biochemical, radiological and histopathological data related to renal osteodystrophy were extracted from the computer records of 81 patients who had been treated by continuous ambulatory peritoneal dialysis (CAPD) for more than two years. Paired bone histopathology was available in 45 of these patients. The majority maintained normal serum ionised and total calcium concentrations, while mean serum phosphate concentration ranged from 1.68 to 1.80 mmol/l. Serum parathyroid hormone concentrations fell significantly in those with high values at the start of CAPD. Five patients underwent parathyroidectomy. Mean serum aluminium concentrations were higher than normal healthy controls and the levels rose further after the addition of aluminium-containing phosphate binders (ACPB). Of the patients with histological evidence of secondary hyperparathyroidism, 82% showed improvement on repeat biopsy. Nine, who had no evidence of osteitis fibrosa at the beginning of CAPD, remained free of bone disease during the study period. Osteomalacia was present in two patients at the onset of CAPD and developed in three more, two of them after parathyroidectomy. Except for one patient, all those with osteomalacia improved after the addition of alfacalcidol and continuation of CAPD. This last patient died with evidence of aluminium deposition in his bones. We conclude that when used as clinically indicated, CAPD, with the addition of calcium carbonate, phosphate binders and alfacalcidol, achieves good control of renal osteo dystrophy in the majority of patients.

scholarly journals Hypercalcemia during pulse vitamin D3 therapy in CAPD patients treated with low calcium dialysate: the role of the decreasing serum parathyroid hormone level.

1997 ◽  
Vol 8 (10) ◽  
pp. 1579-1586
Author(s):  
A Chagnac ◽  
Y Ori ◽  
T Weinstein ◽  
D Zevin ◽  
A Korzets ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Calcium Carbonate ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Early Response ◽  
Relative Role ◽  
Dialysis Patients ◽  
Serum Pth ◽  
Dialysate Calcium

Oral pulse therapy with vitamin D is effective in suppressing parathyroid hormone (PTH) secretion in continuous ambulatory peritoneal dialysis patients with secondary hyperparathyroidism (2'hpt). However, this treatment often leads to hypercalcemia. The goals of the study were: (1) to examine whether the incidence of hypercalcemia decreases when dialysate calcium is reduced from 1.25 to 1.0 mmol/L; (2) to determine the relative role of the factors involved in the pathogenesis of hypercalcemia; and (3) to study the efficacy of a low oral pulse dose of alfacalcidol in preventing the recurrence of 2'hpt. Fourteen continuous ambulatory peritoneal dialysis patients with 2'hpt were treated with pulse oral alfacalcidol and calcium carbonate and dialyzed with a 1.0-mmol (n = 7) or a 1.25-mmol (n = 7) dialysate calcium. The response rate (87%) and the incidence (71%) and severity of hypercalcemia were similar in both groups. In the early response stage, PTH decreased by 70% in both groups, and serum ionized calcium (iCa) increased from 1.18 +/- 0.02 to 1.27 +/- 0.04 mmol/L (P < 0.005) in the 1.0 group and from 1.19 +/- 0.02 to 1.29 +/- 0.02 mmol/L in the 1.25 group (P < 0.005). Nine of the 12 responders had a further decrease in serum PTH, which was associated with an additional increase in iCa from 1.28 +/- 0.02 to 1.47 +/- 0.04 (P < 0.005). Multivariate analysis showed that the early increase in iCa was positively correlated with alfacalcidol dosage (r = 0.69). In contrast, the late increase in iCa was mostly accounted for by the decrease in serum PTH (r = -0.93). This occurred while calcium carbonate, alfacalcidol dosage, and serum 1,25 hydroxy D3 remained unchanged compared with the early response stage. Finally, an alfacalcidol dose of 1 microg twice weekly was unable to maintain serum PTH at an adequate level in the long term. These data show that a reduction in dialysate calcium from 1.25 to 1.0 mmol does not reduce the occurrence of hypercalcemia and suggest that lowering serum PTH reduces the ability of the bone to handle a calcium load within a few weeks, thus causing hypercalcemia.

Scanning Electron Microscopy of Staphylococcus Epidermidis Adherence to Continuous Ambulatory Peritoneal Dialysis Catheters

1985 ◽  
Vol 43 ◽  
pp. 520-521
Author(s):  
William J. Lamoreaux ◽  
David L. Smalley ◽  
Larry M. Baddour ◽  
Alfred P. Kraus
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Sterile Saline ◽  
Intravascular Devices ◽  
Capd Patient ◽  
Scanning Electron

Infections associated with the use of intravascular devices have been documented and have been reported to be related to duration of catheter usage. Recently, Eaton et al. reported that Staphylococcus epidermidis may attach to silastic catheters used in continuous ambulatory peritoneal dialysis (CAPD) treatment. The following study presents findings using scanning electron microscopy (SEM) of S. epidermidis adherence to silastic catheters in an in vitro model. In addition, sections of polyvinyl chloride (PVC) dialysis bags were also evaluated by SEM.The S. epidermidis strain RP62A which had been obtained in a previous outbreak of coagulase-negative staphylococcal sepsis at local hospitals was used in these experiments. The strain produced surface slime on exposure to glucose, whereas a nonadherent variant RP62A-NA, which was also used in these studies, failed to produce slime. Strains were grown overnight on blood agar plates at 37°C, harvested from the surface and resuspended in sterile saline (0.85%), centrifuged (3,000 rpm for 10 minutes) and then washed twice in 0.1 M phosphate-buffered saline at pH 7.0. Organisms were resuspended at a concentration of ca. 106 CFU/ml in: a) sterile unused dianeal at 4.25% dextrose, b) sterile unused dianeal at 1.5% dextrose, c) sterile used dialysate previously containing 4.25% dextrose taken from a CAPD patient, and d) sterile used dialysate previously containing 1.5% dextrose taken from a CAPD patient.

Case Report. Candida lusitaniae peritonitis in a patient on continuous ambulatory peritoneal dialysis

Mycoses ◽  
2002 ◽  
Vol 45 (3-4) ◽  
pp. 120-122 ◽  
Author(s):  
S. Cinar ◽  
A. Nedret Koc ◽  
H. Taskapan ◽  
A. Dogukan ◽  
B. Tokgoz ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Case Report ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Candida Lusitaniae
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