BACKGROUND: Vascular calcification and low bone turnover with a relatively low parathyroid hormone (PTH) often coexist in diabetic patients undergoing haemodialysis. Since calcium salts (CaS) are used extensively as primary phosphate binders and have been associated with progressive vascular calcification, we studied the effects of CaS on coronary arteries and parathyroid activity in incident haemodialysis diabetic patients. METHODS: We measured the change in coronary artery calcium scores (CACS) with sequential electron beam computed tomography (EBCT) in 64 diabetic and 45 non-diabetic patients, randomized to CaS or sevelamer within 90 days of starting haemodialysis. CACS measurements were repeated after 6, 12 and 18 months. Serum intact PTH (iPTH), calcium and phosphorus were serially tested. RESULTS: During the study period, serum phosphate was similar in diabetic and non-diabetic patients. Serum calcium levels were similar at baseline (2.3+/-0.25 mmol/l for both) and increased significantly with CaS treatment (P<0.05) both in diabetic and non-diabetic patients but not with sevelamer. Diabetic patients treated withCaS showed a significantly greater CACS progression than sevelamer-treated patients (median increase 177 vs 27; P=0.05). During follow-up, diabetic patients receiving CaS were significantly more likely to develop serum iPTH values<16 pmol/l than diabetic patients treated withsevelamer (33% vs 6%, P=0.005) and had a lower mean iPTH level (24+/-16 vs 31+/-14 pmol/l; P=0.038). CONCLUSIONS: The management of hyperphosphataemia with CaS in haemodialysis diabetic patients is associated with a significantly greater progression of CACS than with sevelamer. These effects are accompanied by iPTH changes suggestive of low bone turnover.
RCT Entities:
BACKGROUND:Vascular calcification and low bone turnover with a relatively low parathyroid hormone (PTH) often coexist in diabeticpatients undergoing haemodialysis. Since calcium salts (CaS) are used extensively as primary phosphate binders and have been associated with progressive vascular calcification, we studied the effects of CaS on coronary arteries and parathyroid activity in incident haemodialysis diabeticpatients. METHODS: We measured the change in coronary artery calcium scores (CACS) with sequential electron beam computed tomography (EBCT) in 64 diabetic and 45 non-diabeticpatients, randomized to CaS or sevelamer within 90 days of starting haemodialysis. CACS measurements were repeated after 6, 12 and 18 months. Serum intact PTH (iPTH), calcium and phosphorus were serially tested. RESULTS: During the study period, serum phosphate was similar in diabetic and non-diabeticpatients. Serum calcium levels were similar at baseline (2.3+/-0.25 mmol/l for both) and increased significantly with CaS treatment (P<0.05) both in diabetic and non-diabeticpatients but not with sevelamer. Diabeticpatients treated with CaS showed a significantly greater CACS progression than sevelamer-treated patients (median increase 177 vs 27; P=0.05). During follow-up, diabeticpatients receiving CaS were significantly more likely to develop serum iPTH values<16 pmol/l than diabeticpatients treated with sevelamer (33% vs 6%, P=0.005) and had a lower mean iPTH level (24+/-16 vs 31+/-14 pmol/l; P=0.038). CONCLUSIONS: The management of hyperphosphataemia with CaS in haemodialysis diabeticpatients is associated with a significantly greater progression of CACS than with sevelamer. These effects are accompanied by iPTH changes suggestive of low bone turnover.
Authors: Harin Rhee; Sang Heon Song; Ihm Soo Kwak; Soo Bong Lee; Dong Won Lee; Eun Young Seong; Il Young Kim Journal: Clin Exp Nephrol Date: 2012-01-05 Impact factor: 2.801
Authors: Juan Antonio Garcia-Bello; Rita A Gómez-Díaz; Alicia Contreras-Rodríguez; Juan O Talavera; Rafael Mondragón-González; Lorena Sanchez-Barbosa; Margarita Diaz-Flores; Adan Valladares-Salgado; Juan Manuel Gallardo; Alejandra Aguilar-Kitsu; Jesus Lagunas-Munoz; Niels H Wacher Journal: Pediatr Nephrol Date: 2014-02 Impact factor: 3.714
Authors: Suresh Mathew; Richard J Lund; Lala R Chaudhary; Theresa Geurs; Keith A Hruska Journal: J Am Soc Nephrol Date: 2008-04-30 Impact factor: 10.121