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Calcium carbonate as a phosphate binder in children on continuous ambulatory peritoneal dialysis and hemodialysis
M Sieniawska1, M Roszkowska-Blaim, J Weglarska
1Department of Paediatrics and Nephrology, Medical Academy, Warszawa, Poland.
Insights
Calcium carbonate effectively controls serum phosphorus in children with end-stage renal disease (ESRD). Individualized dosing improved phosphorus control and reduced hypercalcemia episodes compared to fixed dosing.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Clinical Pharmacology
Background:
- Children with end-stage renal disease (ESRD) often experience hyperphosphatemia, a critical complication.
- Managing serum phosphorus levels is essential to prevent secondary hyperparathyroidism and cardiovascular complications in pediatric ESRD patients.
Purpose of the Study:
- To evaluate the efficacy of calcium carbonate (CaCO3) in controlling serum phosphorus levels in children with ESRD.
- To compare the effectiveness of CaCO3 in retrospective (Group I) versus prospective (Group II) patient cohorts.
- To assess the influence of concomitant aluminum hydroxide (Al(OH)3) and varying dihydrotachysterol (DHT) doses on phosphorus control.
Main Methods:
- Retrospective analysis of 16 pediatric ESRD patients (Group I) treated with CaCO3 (100-800 mg/kg/day) with or without Al(OH)3 and varying DHT doses.
- Prospective observation of 25 pediatric ESRD patients (Group II) treated with CaCO3 and DHT, with or without prior Al(OH)3 exposure.
- CaCO3 doses were adjusted to maintain serum calcium levels between 5.0-5.5 mEq/l.
Main Results:
- In Group I (retrospective), CAPD patients showed better phosphorus control than HD patients, but with more frequent hypercalcemia episodes.
- Neither concomitant Al(OH)3 use nor DHT dosage variations significantly impacted serum phosphorus levels.
- Group II (prospective) demonstrated less pronounced differences in serum phosphorus and hypercalcemia frequency, potentially due to more precise CaCO3 dose titration.
- Past Al(OH)3 use in Group II was associated with more frequent hypercalcemia episodes.
Conclusions:
- Calcium carbonate is an effective agent for managing serum phosphorus in pediatric ESRD.
- Individualized titration of CaCO3 doses is crucial for optimizing phosphorus control and minimizing hypercalcemia.
- The use of aluminum hydroxide may increase the risk of hypercalcemia in pediatric ESRD patients on calcium-based phosphate binders.
Abstract:
The aim of the study was the evaluation of the efficacy of calcium carbonate (CaCO3) in the control of serum phosphorus level in children with ESRD. Sixteen patients (group I) were evaluated retrospectively, 25 pts (group II) were observed prospectively. The pts from group I were treated with CaCO3 (100-800 mg/kg/day) with or without Al(OH)3 and with different doses of DHT. The pts from group II were treated with CaCO3 and DHT without Al(OH)3 but some of them had obtained Al(OH)3 in the past. The doses of CaCO3 were individually adjusted to maintain the serum calcium level 5.0-5.5 mEq/l. In the pts on CAPD evaluated retrospectively the control of serum phosphorus level was better and episodes of hypercalcemia were more frequent than in the pts on HD. Neither the concomitant use of Al(OH)3 with CaCO3 nor varying the dosage of DHT within assumed range influenced serum phosphorus level. The differences in serum phosphorus level and in the frequency of episodes of hypercalcemia in pts in group II were less obvious then in group I. It may depend on more precise adjustment of CaCO3 doses to the individual needs of these pts. The episodes of hypercalcemia in the group II were more frequent in pts who received Al(OH)3 in the past.