Effects of Calcium Acetate Versus Calcium Carbonate As Oral Phosphate Binder in CKD Patients

Abstract

Hyperphosphatemia and secondary hyperparathyroidism are common complication of CKD lead to significant morbidity. Dietary restriction of phosphorus is limited by the need to provide adequate protein,estimated at roughly 1.0-1.2g protein per kg body weight in most ambulatory patients. Therefore, most of the patient with CKD require an Exogenous Phosphate binder to prevent hyperphosphatemia. 68 patients of CKD (III-V) not on renal replacement therapy were prospectively evaluated in the department of Nephrology, SSMCH & MH, and Dhaka from Jan 2010 Dec 2011 to see the effect of calcium acetate & Calcium Carbonate as phosphate binder. Patients were subdivided into two equal groups, Group A (received calcium acetate, 667 mg BD) Group B (received calcium carbonate, 1250 mg BD). Both the group were matched for age, sex, BMI & renal function. All patients were withdrawn from any phosphate binder and calcitriol 2 weeks ago & restricted to high protein (0.8 gm/day) & phosphate containing diet. After a wash out period, group A had taken calcium acetate and group B had taken calcium carbonate. All the biochemical parameters (S. PO,, S. Ca++, S.Creatinine & iPTH) were estimated at O month, 1st month, 2nd month & 3rd month. One month after intervention showed that serum calcium and serum phosphate were significantly reduced in acetate group than those in calcium carbonate group (P=0.03 & P=0.01). 2nd month after intervention calcium acetate group showed significant reduction of calcium in comparison to calcium carbonate group (P<0.001) & serum phosphate of calcium acetate group decreased further & its difference with calcium carbonate group was significant (P=0.001). At the end of 3rd month calcium acetate group shows a considerable reduction of serum calcium as such there was significant difference between the groups with respect to the variables (P=<0.001). Serum phosphate of calcium acetate group also decreases faster causing a much wider difference with that of calcium carbonate group (P=0.005). After end of the study iPTH decreased proportionately in both groups & serum creatinine was not significantly in either group

J. Dhaka National Med. Coll. Hos. 2016; 22 (01): 37-41