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Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study)

Wajeh Y Qunibi1, Robert E Hootkins, Laveta L McDowell

  • 1Department of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas 78229-3900, USA.

Kidney International
|April 17, 2004
PubMed

Insights

Calcium acetate is more effective than sevelamer hydrochloride in managing hyperphosphatemia for hemodialysis patients. It better controls phosphorus and calcium-x-phosphorus product levels, making it the preferred treatment choice.

Area of Science:

  • Nephrology
  • Clinical Pharmacology
  • Internal Medicine

Background:

  • Hyperphosphatemia is a significant complication in hemodialysis patients, contributing to secondary hyperparathyroidism, renal osteodystrophy, and increased mortality.
  • Elevated serum phosphorus and calcium-phosphate product are key indicators of poor outcomes in chronic kidney disease patients undergoing dialysis.

Purpose of the Study:

  • To compare the efficacy of calcium acetate and sevelamer hydrochloride in achieving target serum phosphorus levels (<=5.5 mg/dL) and calcium x phosphorus product (<=55 mg(2)/dL(2)).
  • To evaluate which phosphate binder is superior for managing mineral and bone disorder in hemodialysis patients.

Main Methods:

  • An 8-week, randomized, double-blind study involving 100 hemodialysis patients.
  • Patients were randomized to receive either calcium acetate or sevelamer hydrochloride.
  • Primary endpoints included time-averaged serum phosphorus and calcium x phosphorus product levels.

Main Results:

  • Calcium acetate treatment resulted in significantly lower serum phosphorus (P=0.0006) and calcium x phosphorus product (P=0.022) compared to sevelamer hydrochloride.
  • Calcium acetate recipients were more likely to achieve goal phosphorus (OR 2.37) and calcium x phosphorus product (OR 2.16) levels.
  • Transient hypercalcemia was observed in 16.7% of calcium acetate recipients, particularly those on vitamin D therapy. Sevelamer hydrochloride led to lower serum bicarbonate levels (P < 0.0001).

Conclusions:

  • Calcium acetate demonstrates superior efficacy in controlling serum phosphorus and the calcium-phosphate product compared to sevelamer hydrochloride.
  • In the absence of hypercalcemia, calcium acetate is recommended as the primary treatment for hyperphosphatemia in hemodialysis patients.
  • Further consideration of calcium-related side effects and acid-base balance is warranted when selecting phosphate binders.
Abstract

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