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Magnesium carbonate for phosphate control in patients on hemodialysis. A randomized controlled trial.

Tzanakis IP, Papadaki AN, Wei M, Kagia S, Spadidakis VV, Kallivretakis NE, Oreopoulos DG - Int Urol Nephrol (2008)

Bottom Line: Magnesium salts bind dietary phosphorus, but their use in renal patients is limited due to their potential for causing side effects.At month 6, iPTH levels did not differ between groups: 251 vs. 212 pg/ml, P=ns.At month 6 the percentages of patients with serum levels of phosphate, Ca x P product and iPTH that fell within the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines were similar in both groups, whereas more patients in the MgCO(3) group (17/23; 73.91%) than in the CaCO(3) group (5/20, 25%) had serum Ca levels that fell within these guidelines, with the difference being significant at P<0.01.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, General Hospital of Chania, 18, Michali Mefa St, Chania-Crete PC 73100, Greece. ioatza@otenet.gr

ABSTRACT

Background: Magnesium salts bind dietary phosphorus, but their use in renal patients is limited due to their potential for causing side effects. The aim of this study was to evaluate the efficacy and safety of magnesium carbonate (MgCO(3)) as a phosphate-binder in hemodialysis patients.

Methods: Forty-six stable hemodialysis patients were randomly allocated to receive either MgCO(3) (n=25) or calcium carbonate (CaCO(3)), (n=21) for 6 months. The concentration of Mg in the dialysate bath was 0.30 mmol/l in the MgCO(3) group and 0.48 mmol/l in the CaCO(3) group.

Results: Only two of 25 patients (8%) discontinued ingestion of MgCO(3) due to complications: one (4%) because of persistent diarrhea, and the other (4%) because of recurrent hypermagnesemia. In the MgCO(3) and CaCO(3) groups, respectively, time-averaged (months 1-6) serum concentrations were: phosphate (P), 5.47 vs. 5.29 mg/dl, P=ns; Ca, 9.13 vs. 9.60 mg/dl, P<0.001; Ca x P product, 50.35 vs. 50.70 (mg/dl)(2), P=ns; Mg, 2.57 vs. 2.41 mg/dl, P=ns; intact parathyroid hormone (iPTH), 285 vs. 235 pg/ml, P<0.01. At month 6, iPTH levels did not differ between groups: 251 vs. 212 pg/ml, P=ns. At month 6 the percentages of patients with serum levels of phosphate, Ca x P product and iPTH that fell within the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines were similar in both groups, whereas more patients in the MgCO(3) group (17/23; 73.91%) than in the CaCO(3) group (5/20, 25%) had serum Ca levels that fell within these guidelines, with the difference being significant at P<0.01.

Conclusion: Our study shows that MgCO(3) administered for a period of 6 months is an effective and inexpensive agent to control serum phosphate levels in hemodialysis patients. The administration of MgCO(3) in combination with a low dialysate Mg concentration avoids the risk of severe hypermagnesemia.

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Monthly follow-up of serum PTH (siPTH)
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Fig4: Monthly follow-up of serum PTH (siPTH)

Mentions: Of the 26 patients enrolled in the MgCO3 group, one dropped out due to non-compliance. Of the remaining 25 patients, two (8%) discontinued ingestion of MgCO3 and dropped out: one (4%) because of persistent diarrhea, and one (4%) because of recurrent hypermagnesemia. Of the 25 patients in the CaCO3 group; five were removed from the study (two received a kidney transplant, one died (pneumonia), one suffered a stroke and was unable to swallow tablets and one moved to another hospital). The use of phosphate-binders and vitamin D by the patients before the washout period is given in Table 1. Patients’ mean serum values at baseline and at the end of the follow-up period are shown in Tables 2 and 3. The monthly follow-up of the mean biochemical parameters are shown in Figs. 1–4. The mean Kt/Vurea was 1.379 ± 0.026 in the MgCO3 and 1.381 ± 0.027 in the CaCO3 group.Table 1


Magnesium carbonate for phosphate control in patients on hemodialysis. A randomized controlled trial.

Tzanakis IP, Papadaki AN, Wei M, Kagia S, Spadidakis VV, Kallivretakis NE, Oreopoulos DG - Int Urol Nephrol (2008)

Monthly follow-up of serum PTH (siPTH)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2268719&req=5

Fig4: Monthly follow-up of serum PTH (siPTH)
Mentions: Of the 26 patients enrolled in the MgCO3 group, one dropped out due to non-compliance. Of the remaining 25 patients, two (8%) discontinued ingestion of MgCO3 and dropped out: one (4%) because of persistent diarrhea, and one (4%) because of recurrent hypermagnesemia. Of the 25 patients in the CaCO3 group; five were removed from the study (two received a kidney transplant, one died (pneumonia), one suffered a stroke and was unable to swallow tablets and one moved to another hospital). The use of phosphate-binders and vitamin D by the patients before the washout period is given in Table 1. Patients’ mean serum values at baseline and at the end of the follow-up period are shown in Tables 2 and 3. The monthly follow-up of the mean biochemical parameters are shown in Figs. 1–4. The mean Kt/Vurea was 1.379 ± 0.026 in the MgCO3 and 1.381 ± 0.027 in the CaCO3 group.Table 1

Bottom Line: Magnesium salts bind dietary phosphorus, but their use in renal patients is limited due to their potential for causing side effects.At month 6, iPTH levels did not differ between groups: 251 vs. 212 pg/ml, P=ns.At month 6 the percentages of patients with serum levels of phosphate, Ca x P product and iPTH that fell within the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines were similar in both groups, whereas more patients in the MgCO(3) group (17/23; 73.91%) than in the CaCO(3) group (5/20, 25%) had serum Ca levels that fell within these guidelines, with the difference being significant at P<0.01.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, General Hospital of Chania, 18, Michali Mefa St, Chania-Crete PC 73100, Greece. ioatza@otenet.gr

ABSTRACT

Background: Magnesium salts bind dietary phosphorus, but their use in renal patients is limited due to their potential for causing side effects. The aim of this study was to evaluate the efficacy and safety of magnesium carbonate (MgCO(3)) as a phosphate-binder in hemodialysis patients.

Methods: Forty-six stable hemodialysis patients were randomly allocated to receive either MgCO(3) (n=25) or calcium carbonate (CaCO(3)), (n=21) for 6 months. The concentration of Mg in the dialysate bath was 0.30 mmol/l in the MgCO(3) group and 0.48 mmol/l in the CaCO(3) group.

Results: Only two of 25 patients (8%) discontinued ingestion of MgCO(3) due to complications: one (4%) because of persistent diarrhea, and the other (4%) because of recurrent hypermagnesemia. In the MgCO(3) and CaCO(3) groups, respectively, time-averaged (months 1-6) serum concentrations were: phosphate (P), 5.47 vs. 5.29 mg/dl, P=ns; Ca, 9.13 vs. 9.60 mg/dl, P<0.001; Ca x P product, 50.35 vs. 50.70 (mg/dl)(2), P=ns; Mg, 2.57 vs. 2.41 mg/dl, P=ns; intact parathyroid hormone (iPTH), 285 vs. 235 pg/ml, P<0.01. At month 6, iPTH levels did not differ between groups: 251 vs. 212 pg/ml, P=ns. At month 6 the percentages of patients with serum levels of phosphate, Ca x P product and iPTH that fell within the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines were similar in both groups, whereas more patients in the MgCO(3) group (17/23; 73.91%) than in the CaCO(3) group (5/20, 25%) had serum Ca levels that fell within these guidelines, with the difference being significant at P<0.01.

Conclusion: Our study shows that MgCO(3) administered for a period of 6 months is an effective and inexpensive agent to control serum phosphate levels in hemodialysis patients. The administration of MgCO(3) in combination with a low dialysate Mg concentration avoids the risk of severe hypermagnesemia.

Show MeSH
Related in: MedlinePlus