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Long-term suppression of hyperparathyroidism by phosphate binders in uremic children
K Tamanaha1, R H Mak, S P Rigden
1Evelina Children's Hospital, United Medical School of Guy, London, UK.
Insights
Calcium carbonate effectively suppresses hyperparathyroidism in children with chronic renal failure. This phosphate binder maintained normal parathyroid hormone levels without impacting kidney function over five years.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Internal Medicine
Background:
- Chronic renal failure (CRF) in children often leads to secondary hyperparathyroidism due to hyperphosphatemia.
- Phosphate binders are crucial for managing mineral and bone disorders in pediatric CRF.
- Long-term efficacy and safety of phosphate binders in non-dialyzed pediatric CRF patients require further investigation.
Purpose of the Study:
- To evaluate the long-term effectiveness of conservative management, including phosphate binders, in children with stable CRF.
- To assess the impact of calcium carbonate as a primary phosphate binder on serum parathyroid hormone (PTH) levels and renal function.
- To determine the optimal phosphate binder for long-term suppression of hyperphosphatemia and hyperparathyroidism in pediatric uremic patients.
Main Methods:
- A cohort of 45 children with stable CRF, not on dialysis, received conservative treatment.
- Treatment included dietary phosphate restriction and high-dose phosphate binders (initially aluminum hydroxide and calcium carbonate, predominantly calcium carbonate later).
- Serum immunoreactive parathyroid hormone (iPTH) and renal function were monitored for up to 5 years.
Main Results:
- Serum iPTH concentrations significantly decreased, normalizing within 1 year and remaining stable throughout the treatment period.
- No significant decline in renal function was observed during the 5-year follow-up.
- Calcium carbonate demonstrated sustained efficacy in controlling hyperparathyroidism.
Conclusions:
- Calcium carbonate is a highly effective phosphate binder for the long-term management of hyperphosphatemia and secondary hyperparathyroidism in pediatric CRF.
- Conservative management with calcium carbonate can normalize PTH levels and preserve renal function in non-dialyzed uremic children.
- Calcium carbonate should be considered the preferred phosphate binder for sustained control of mineral and bone disease in this population.
Abstract:
Forty-five children with stable chronic renal failure, not on dialysis, were treated conservatively with a regimen of mild dietary phosphate restriction and high-dose phosphate binders for up to 5 years. Both aluminum hydroxide and calcium carbonate were used initially, but almost all patients were taking calcium carbonate towards the end of the period. Serum immunoreactive parathyroid hormone concentrations were significantly decreased and were within the normal range after 1 year and remained normal during treatment. There was no significant change in renal function over the same treatment period. We conclude that calcium carbonate should be used as the phosphate binder of choice in the long-term suppression of hyperphosphatemia and hyperparathyroidism in uremic children.