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Oral calcium carbonate as phosphate-binder in infants and children with chronic renal failure
Insights
Calcium carbonate (CaCO3) effectively lowers phosphate levels in children with chronic renal failure (CRF), offering a safer alternative to aluminum-based binders and improving bone health.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Biochemistry
Background:
- Aluminum-based phosphate binders pose toxicity risks in chronic renal failure (CRF) patients.
- Alternative phosphate binders are needed for managing CRF, particularly in pediatric populations.
Purpose of the Study:
- To evaluate the efficacy and safety of calcium carbonate (CaCO3) as a phosphate binder in pediatric CRF patients.
- To assess the impact of CaCO3 on mineral metabolism and bone disease in children with CRF.
Main Methods:
- A cohort of 12 pediatric CRF patients received CaCO3 as a phosphate binder.
- Treatment involved CaCO3, sodium bicarbonate, and vitamin D analogs, with regular monitoring of serum calcium, phosphate, and bicarbonate.
- Bone X-rays were obtained to assess renal osteodystrophy.
Main Results:
- CaCO3 significantly reduced serum phosphate levels (from 6.3 to 4.2 mg/dl) and alkaline phosphatase (from 486 to 168 IU).
- Serum calcium levels increased significantly (from 8.9 to 10.3 mg/dl) without a significant increase in the Ca x P product.
- Bone X-rays indicated healing or prevention of renal osteodystrophy, with only one mild hypercalcemia episode.
Conclusions:
- CaCO3 is an effective and safe phosphate binder for pediatric CRF patients.
- CaCO3 improves mineral metabolism and helps manage renal osteodystrophy in children with CRF.
- CaCO3 represents a viable alternative to aluminum-based binders, mitigating toxicity concerns.
Abstract:
In view of the known toxicity of aluminum, we studied the effects of CaCO3 as an alternative phosphate binder in 12 chronic renal failure (CRF) children during 152 patient-months. Mean (+/- SD) serum creatinine concentration rose during that period from 3.7 +/- 1.8 to 5.1 +/- 3.0 mg/dl. 8 patients received CaCO3 from the start, and 4 were switched from A1(OH)3 after 2 months of interruption. In addition to CaCO3 (0.1-0.3 mg/kg BW) all patients received NaHCO3, and all but two received 1 alpha-hydroxyvitamin D3 [1 alpha(OH)D3] or dihydrotachysterol (DHT). Urine and blood variables were checked every 4-6 weeks and medication dosages were adjusted accordingly, aiming to keep serum Ca at 10.4-10.8 mg/dl, serum Pi at 3.5-5.5 mg/dl, and serum HCO-3 above 18 mEq/l. Bone X-rays were obtained every 6-9 months. With treatment, mean serum Ca increased from 8.9 +/- 0.7 to 10.3 +/- 0.4 mg/dl (p less than 0.01), serum Pi decreased from 6.3 +/- 0.9 to 4.2 +/- 0.5 mg/dl (p less than 0.01), and the mean Ca X P product decreased slightly and insignificantly. Mean serum alkaline phosphatase levels decreased significantly from 486 +/- 251 to 168 +/- 28 IU (p less than 0.01). Bone X-rays at the end of the study showed either healing of renal osteodystrophy or its prevention. Only one episode of mild hypercalcemia (serum Ca 11.7 mg/dl) was observed in 1 patient, but his Ca X P product remained low.(ABSTRACT TRUNCATED AT 250 WORDS)