Calcium citrate, a nonaluminum-containing phosphate-binding agent for treatment of CRF

• Published in: Kidney international Vol. 33; no. 1; pp. 95 - 99
• Main Authors: Cushner, Howard M., Copley, John B., Lindberg, Jill S., Foulks, Charles J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.1988
• Subjects: Adult; Aged; Alkaline Phosphatase - blood; Aluminum - adverse effects; Aluminum - therapeutic use; Calcium - blood; Citrates - therapeutic use; Citric Acid; Clinical Trials as Topic; Female; Humans; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - drug therapy; Male; Middle Aged; Parathyroid Hormone - blood; Phosphates - blood
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/ki.1988.15

Calcium citrate, a nonaluminum-containing phosphate-binding agent for treatment of CRF. Calcium citrate was evaluated as a dietary phosphate binder in 81 patients with end-stage renal disease. These patients were grouped as follows: Group 1, 43 patients who were treated with calcium citrate; and Group 2 (the control group), 38 patients who were treated with aluminum-containing compounds. Blood chemistries were measured monthly and medications adjusted to maintain the following levels: serum calcium, >9 mg/dl; serum phosphorus, < 5.5 mg/dl; and total CO2 content, >22 mmol/liter. At the end of the treatment period, the following serum values were obtained in Groups 1 and 2, respectively: calcium, 9.6 ± 1.2 mg/dl (mean ± SD) versus 8.9 ± 0.8 mg/dl (P < 0.001); phosphorus, 5.5 ± 1.9 mg/dl versus 7.0 ± 2.3 mg/dl (P < 0.005); and calcium-phosphate product, 52 ± 18 versus 61 ± 21 (P < 0.05). Differences in alkaline phosphatase, total CO2 content, and C-terminal parathyroid hormone (C-PTH) values were not statistically significant between the two groups. Fifteen patients in Group 1 were then switched to aluminum-containing compounds and chemistries were compared one month later. During calcium citrate therapy, serum calcium was significantly higher, while C-PTH and serum alkaline phosphatase were significantly reduced. No difference was noted in serum phosphorous and total CO2 content. A questionnaire completed by 17 patients in Group 1 documented excellent patient tolerance to calcium citrate. Hypercalcemia (>10.5 mg/dl) was the only significant complication, but only one patient became symptomatic. We conclude that, as a phosphate binder, calcium citrate is at least as effective as aluminum-containing compounds.