Abstract
BackgroundHyperphosphatemia is one of the common complications in patients undergoing hemodialysis. Although calcium carbonate (CaC) is often used to control serum inorganic phosphorus level in dialysis patients, co-administration of gastric acid reducers (ARs) may interfere with the phosphate binding effect of CaC. We performed a retrospective medical chart review to study whether ARs attenuate the hypophosphatemic effect of CaC in patients undergoing hemodialysis.MethodsOne hundred and eight chronic hemodialysis patients receiving either CaC alone or CaC concomitant with one of the ARs (proton pump inhibitors and histamine H2-receptor antagonists) were retrieved from the medical charts in Juntendo University Nerima Hospital. The patients were subdivided according to the interval between hemodialysis sessions (interdialysis interval of 48 or 72 h). A multivariate analysis was performed to identify clinical covariates associated with the variability of serum inorganic phosphorus levels. The study protocol was approved by the Institutional Review Board before the study was begun.ResultsAmong patients on hemodialysis with a 72-h interdialysis interval, the magnitude of increase in serum inorganic phosphorus concentration in patients receiving CaC and AR was significantly greater than in those receiving CaC alone. While a similar trend was observed among patients with a 48-h interdialysis interval, the difference did not reach a significant level. A multivariate regression analysis revealed that concomitant administration of ARs with CaC and a longer interdialysis interval (72 h) were significantly and independently associated with the magnitude of increase in serum phosphorus concentration between dialysis sessions. No significant differences in albumin-corrected serum calcium concentrations and incidence of pathological fractures were observed between patients receiving CaC alone and those receiving CaC with ARs.ConclusionsConcomitant use of ARs with CaC may attenuate the hypophosphatemic effect of CaC in patients undergoing chronic hemodialysis. When hemodialysis patients require prescription of ARs for the prevention of upper gastrointestinal mucosal diseases (such as peptic ulcer), it may be prudent to choose a phosphate binder other than CaC.
Highlights
Hyperphosphatemia is one of the common complications in patients undergoing hemodialysis
Concomitant use of Acid reducer (AR) with calcium carbonate (CaC) may attenuate the hypophosphatemic effect of CaC in patients undergoing chronic hemodialysis
Patients Among the 526 hemodialysis patients taking CaC as a phosphate binder at Juntendo University Nerima Hospital during the study period, 108 patients were eligible to enter the present study according to the inclusion and exclusion criteria (Fig. 1)
Summary
Hyperphosphatemia is one of the common complications in patients undergoing hemodialysis. Calcium carbonate (CaC) is often used to control serum inorganic phosphorus level in dialysis patients, co-administration of gastric acid reducers (ARs) may interfere with the phosphate binding effect of CaC. Hyperphosphatemia is one of the common complications in patients with end-stage renal disease (ESRD) undergoing hemodialysis. Hyperphosphatemia alone or in combination with hypercalcemia has been associated with increased cardiovascular and musculoskeletal morbidity and mortality in hemodialysis patients [2, 3]. In this context, management of serum inorganic phosphorus level is clinically important. As for the choice of phosphate binder, calcium carbonate (CaC) may be preferred to lanthanum carbonate or sevelamer hydrochloride when safety profile or lower cost is of primary concern
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