Mineral metabolismCalcium salts in the treatment of hyperphosphatemia in hemodialysis patientsNolan, Charles R.; Qunibi, Wajeh Y. Author Information University of Texas Health Sciences Center, San Antonio, Texas, USA Correspondence to Charles R. Nolan, MD, Organ Transplant, University of Texas Health Sciences Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA Tel: +1 210 567 5777; fax: +1 210 567 5122; e-mail: [email protected] Abbreviations CARE: Calcium Acetate Renagel Evaluation (study) EBT: electron beam tomography ESRD: end-stage renal disease iPTH: intact parathyroid hormone Current Opinion in Nephrology and Hypertension: July 2003 - Volume 12 - Issue 4 - p 373-379 Buy Abstract Purpose of review Hyperphosphatemia in patients with end-stage renal disease leads to secondary hyperparathyroidism and renal osteodystrophy, and is independently associated with mortality risk. How hyperphosphatemia increases mortality risk is unknown but it may promote cardiovascular calcification. It is recommended that dialysis patients be treated to maintain normal serum phosphorus. Although calcium-based phosphate binders are cost-effective, their long-term safety has been questioned because of their postulated role in progression of cardiovascular calcification. In this regard, sevelamer hydrochloride has been recommended as an alternative phosphate binder. In this review, we will examine these issues and provide rational guidelines for the use of calcium-based phosphate binders. Recent findings Results from the calcium acetate Renagel evaluation study indicate that calcium acetate is more effective than sevelamer in controlling serum phosphorus and calcium x phosphorus product in hemodialysis patients. However, in the Treat-to-Goal study dialysis patients treated with sevelamer had less progression of coronary and aortic calcification than patients treated with calcium-containing binders. The mechanism underlying the slower rate of progression of cardiovascular calcification in sevelamer-treated patients remains uncertain but may relate to decreased calcium loading or to dramatic reductions in LDL cholesterol. Summary At present, evidence incriminating calcium-containing phosphate binders in the progression of cardiovascular calcification in end-stage renal disease remains largely circumstantial. As calcium acetate is more efficacious and cost-effective than sevelamer, it remains an accepted first-line drug. Treatment with sevelamer hydrochloride should be considered for patients with persistent hypercalcemia during calcium-based binder therapy despite appropriate adjustment of vitamin D therapy. © 2003 Lippincott Williams & Wilkins, Inc.