NDT Advance Access originally published online on April 3, 2008
Nephrology Dialysis Transplantation 2008 23(9):2861-2867; doi:10.1093/ndt/gfn151
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Calcium load during administration of calcium carbonate or sevelamer in individuals with normal renal function
1 Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 2 Department of Endocrinology, Limbach Laboratory, 69126 3 Institute for Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120 4 Heimdialyse, Bergheimerstr. 59-61, 69115, Heidelberg, Germany
Correspondence and offprint requests to: Jürgen Bommer, Heimdialyse, Bergheimerstr. 59-61, 69115 Heidelberg, Germany. Tel: +49-6221-97900; Fax: +49-6221-979039; E-mail: juergen_bommer{at}t-online.de
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Abstract |
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Background. Under steady-state conditions urinary calcium (Ca) excretion corresponds to the Ca load in healthy subjects. However, in chronic haemodialysis patients reliable data on Ca load are not available. In these patients Ca-containing phosphate binders are suspected to play a role in the progression of arteriosclerosis via increased but not quantified Ca load. The present study evaluated the effect of calcium carbonate (CC) and sevelamer hydrochloride (SEV), a calcium-free phosphate binder, on serum Ca and urinary Ca excretion in healthy individuals.
Methods. Twelve healthy male individuals were included in a monocentre, randomized, single-blind, placebo-controlled, three-way crossover phase I study. Concurrently with their meals, participants received 4 x 2 tablets of SEV (800 mg), CC (500 mg) or placebo for 6 days with 1-week washout between the treatment periods. During the study, weekly blood samples were taken and 24-h urine was collected each day for measurement of calcium, magnesium, phosphorus, chloride and iPTH.
Results. Mean daily urinary phosphorus excretion was significantly lower in subjects undergoing SEV treatment compared to those taking placebo (P < 0.001). Mean daily total urinary excretion of calcium was significantly higher in CC-treated participants compared to those receiving placebo (P < 0.001). Mean 24-h calcium excretion during the 6 treatment days was 6.60 ± 2.62 mmol [265 ± 105 mg] (CC) versus 5.15 ± 2.16 mmol [206 ± 87 mg] (SEV) versus 4.95 ± 1.63 mmol [198 ± 65 mg] (Placebo). Taking into account nutritional calcium intake estimated from dietary records fractional calcium absorption was 8.7% (CC), 13.3% (placebo) and 14.8% (sevelamer).
Conclusion. Intake of calcium carbonate compared to placebo in contrast to sevelamer in healthy individuals was associated with increased total urinary calcium excretion indicating an increased calcium load due to increased intestinal calcium absorption.
Keywords: calcium carbonate; calcium load; serum calcium; sevelamer; urinary calcium excretion
Received for publication: 6. 8.07
Accepted in revised form: 26. 2.08
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