Metabolic and Skeletal Effects of Low and High Doses of Calcium Acetate in Patients with Preterminal Chronic Renal Failure

Background: Secondary hyperparathyroidism commonly evolves, as the glomerular filtration rate falls. The metabolic and skeletal effects of a possible remedy, calcium acetate, have not been studied in patients with preterminal chronic renal failure. Methods: Men with a mean creatinine clearance of ap...

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Veröffentlicht in:American journal of nephrology 2002-09, Vol.22 (5-6), p.445-454
Hauptverfasser: Phelps, Kenneth R., Stern, Marc, Slingerland, Alice, Heravi, Mahin, Strogatz, David S., Haqqie, Syed S.
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container_end_page 454
container_issue 5-6
container_start_page 445
container_title American journal of nephrology
container_volume 22
creator Phelps, Kenneth R.
Stern, Marc
Slingerland, Alice
Heravi, Mahin
Strogatz, David S.
Haqqie, Syed S.
description Background: Secondary hyperparathyroidism commonly evolves, as the glomerular filtration rate falls. The metabolic and skeletal effects of a possible remedy, calcium acetate, have not been studied in patients with preterminal chronic renal failure. Methods: Men with a mean creatinine clearance of approximately 30 ml/min took calcium acetate for 24 weeks at doses which provided 507 or 1,521 mg calcium/day with meals. Metabolic determinations were made at intervals of 4–8 weeks, and the bone mineral density (BMD) was measured at the beginning and at the end of the trial. Results: The low-dose regimen produced no metabolic or skeletal effect. In subjects prescribed the high-dose regimen, the 24-hour urine phosphorus excretion fell from 0.53 mg/mg creatinine to values ranging from 0.34 to 0.41 mg/mg creatinine. The theoretical phosphorus threshold concentration rose by a maximum of 38.6%, and the serum phosphorus concentration did not change. The mean serum calcium concentration rose by a maximum of 7.2%. The mean fractional changes in parathyroid hormone and 1,25-dihydroxyvitamin D concentrations ranged from –27.0 to –39.6% and from –5.0 to –20.3%, respectively. The BMD increased at L1, L3, and L4. Conclusion: Calcium acetate prescribed to deliver 1,521 mg calcium/day with meals reduced parathyroid hormone and 1,25-dihydroxyvitamin D concentrations and increased lumbar BMD in men with preterminal chronic renal failure.
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The metabolic and skeletal effects of a possible remedy, calcium acetate, have not been studied in patients with preterminal chronic renal failure. Methods: Men with a mean creatinine clearance of approximately 30 ml/min took calcium acetate for 24 weeks at doses which provided 507 or 1,521 mg calcium/day with meals. Metabolic determinations were made at intervals of 4–8 weeks, and the bone mineral density (BMD) was measured at the beginning and at the end of the trial. Results: The low-dose regimen produced no metabolic or skeletal effect. In subjects prescribed the high-dose regimen, the 24-hour urine phosphorus excretion fell from 0.53 mg/mg creatinine to values ranging from 0.34 to 0.41 mg/mg creatinine. The theoretical phosphorus threshold concentration rose by a maximum of 38.6%, and the serum phosphorus concentration did not change. The mean serum calcium concentration rose by a maximum of 7.2%. The mean fractional changes in parathyroid hormone and 1,25-dihydroxyvitamin D concentrations ranged from –27.0 to –39.6% and from –5.0 to –20.3%, respectively. The BMD increased at L1, L3, and L4. 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The metabolic and skeletal effects of a possible remedy, calcium acetate, have not been studied in patients with preterminal chronic renal failure. Methods: Men with a mean creatinine clearance of approximately 30 ml/min took calcium acetate for 24 weeks at doses which provided 507 or 1,521 mg calcium/day with meals. Metabolic determinations were made at intervals of 4–8 weeks, and the bone mineral density (BMD) was measured at the beginning and at the end of the trial. Results: The low-dose regimen produced no metabolic or skeletal effect. In subjects prescribed the high-dose regimen, the 24-hour urine phosphorus excretion fell from 0.53 mg/mg creatinine to values ranging from 0.34 to 0.41 mg/mg creatinine. The theoretical phosphorus threshold concentration rose by a maximum of 38.6%, and the serum phosphorus concentration did not change. The mean serum calcium concentration rose by a maximum of 7.2%. The mean fractional changes in parathyroid hormone and 1,25-dihydroxyvitamin D concentrations ranged from –27.0 to –39.6% and from –5.0 to –20.3%, respectively. The BMD increased at L1, L3, and L4. Conclusion: Calcium acetate prescribed to deliver 1,521 mg calcium/day with meals reduced parathyroid hormone and 1,25-dihydroxyvitamin D concentrations and increased lumbar BMD in men with preterminal chronic renal failure.</description><subject>Acetates - administration &amp; dosage</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Bone Density - drug effects</subject><subject>Calcitriol - blood</subject><subject>Calcium - blood</subject><subject>Calcium Compounds</subject><subject>Clinical Study</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - metabolism</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nephropathies. 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The mean fractional changes in parathyroid hormone and 1,25-dihydroxyvitamin D concentrations ranged from –27.0 to –39.6% and from –5.0 to –20.3%, respectively. The BMD increased at L1, L3, and L4. Conclusion: Calcium acetate prescribed to deliver 1,521 mg calcium/day with meals reduced parathyroid hormone and 1,25-dihydroxyvitamin D concentrations and increased lumbar BMD in men with preterminal chronic renal failure.</abstract><cop>Basel, Switzerland</cop><pub>Karger</pub><pmid>12381942</pmid><doi>10.1159/000065273</doi><tpages>10</tpages></addata></record>
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subjects Acetates - administration & dosage
Aged
Biological and medical sciences
Bone Density - drug effects
Calcitriol - blood
Calcium - blood
Calcium Compounds
Clinical Study
Humans
Kidney Failure, Chronic - metabolism
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
Parathyroid Hormone - blood
Phosphorus - blood
Phosphorus - urine
Prospective Studies
Renal failure
title Metabolic and Skeletal Effects of Low and High Doses of Calcium Acetate in Patients with Preterminal Chronic Renal Failure
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