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Influence of proton pump inhibitors and histamine H 2 receptor antagonists on serum phosphorus level control by calcium carbonate in patients undergoing hemodialysis: a retrospective medical chart review

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ABSTRACT

Background: Hyperphosphatemia is one of the common complications in patients undergoing hemodialysis. Although calcium carbonate (CaC) is often used to control serum inorganic phosphorus level in dialysis patients, co-administration of gastric acid reducers (ARs) may interfere with the phosphate binding effect of CaC. We performed a retrospective medical chart review to study whether ARs attenuate the hypophosphatemic effect of CaC in patients undergoing hemodialysis.

Methods: One hundred and eight chronic hemodialysis patients receiving either CaC alone or CaC concomitant with one of the ARs (proton pump inhibitors and histamine H2-receptor antagonists) were retrieved from the medical charts in Juntendo University Nerima Hospital. The patients were subdivided according to the interval between hemodialysis sessions (interdialysis interval of 48 or 72 h). A multivariate analysis was performed to identify clinical covariates associated with the variability of serum inorganic phosphorus levels. The study protocol was approved by the Institutional Review Board before the study was begun.

Results: Among patients on hemodialysis with a 72-h interdialysis interval, the magnitude of increase in serum inorganic phosphorus concentration in patients receiving CaC and AR was significantly greater than in those receiving CaC alone. While a similar trend was observed among patients with a 48-h interdialysis interval, the difference did not reach a significant level. A multivariate regression analysis revealed that concomitant administration of ARs with CaC and a longer interdialysis interval (72 h) were significantly and independently associated with the magnitude of increase in serum phosphorus concentration between dialysis sessions. No significant differences in albumin-corrected serum calcium concentrations and incidence of pathological fractures were observed between patients receiving CaC alone and those receiving CaC with ARs.

Conclusions: Concomitant use of ARs with CaC may attenuate the hypophosphatemic effect of CaC in patients undergoing chronic hemodialysis. When hemodialysis patients require prescription of ARs for the prevention of upper gastrointestinal mucosal diseases (such as peptic ulcer), it may be prudent to choose a phosphate binder other than CaC.

No MeSH data available.


Flow chart of patient selection. CaC, calcium carbonate; AR, acid reducer
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Fig1: Flow chart of patient selection. CaC, calcium carbonate; AR, acid reducer

Mentions: Among the 526 hemodialysis patients taking CaC as a phosphate binder at Juntendo University Nerima Hospital during the study period, 108 patients were eligible to enter the present study according to the inclusion and exclusion criteria (Fig. 1). Among them, 23 patients (aged 66 ± 12 years, 14 males) were assigned to the CaC group and 85 (aged 70 ± 12 years, 55 males) to the AR + CaC group. Thirty-six patients (9 and 27 in the CaC and the AR + CaC group, respectively) and 72 patients (14 and 58 in the CaC and the AR + CaC group, respectively) had interdialysis intervals of 48 and 72 h, respectively. Table 1 shows the patients’ demographic data, laboratory tests, underlying diseases and concomitant medications. While the mean daily dose of CaC in the AR + CaC group (2.5 ± 1.3 g/day) tended to be higher than that in the CaC group (1.9 ± 1.1 g/day), the difference did not reach statistical significance (p = 0.062). When the CaC doses were compared between the CaC and AR + CaC groups for interdialysis intervals of 48 and 72 h separately, essentially similar results were obtained (data are not shown). No significant difference in the percentage of patients receiving vitamin D3 analogues was observed between the CaC and AR + CaC groups (p = 0.466). No significant differences were observed between two groups in biochemical data (including pre-HD creatinine and blood urea nitrogen) possibly related to hemodialysis conditions.Fig. 1


Influence of proton pump inhibitors and histamine H 2 receptor antagonists on serum phosphorus level control by calcium carbonate in patients undergoing hemodialysis: a retrospective medical chart review
Flow chart of patient selection. CaC, calcium carbonate; AR, acid reducer
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5120546&req=5

Fig1: Flow chart of patient selection. CaC, calcium carbonate; AR, acid reducer
Mentions: Among the 526 hemodialysis patients taking CaC as a phosphate binder at Juntendo University Nerima Hospital during the study period, 108 patients were eligible to enter the present study according to the inclusion and exclusion criteria (Fig. 1). Among them, 23 patients (aged 66 ± 12 years, 14 males) were assigned to the CaC group and 85 (aged 70 ± 12 years, 55 males) to the AR + CaC group. Thirty-six patients (9 and 27 in the CaC and the AR + CaC group, respectively) and 72 patients (14 and 58 in the CaC and the AR + CaC group, respectively) had interdialysis intervals of 48 and 72 h, respectively. Table 1 shows the patients’ demographic data, laboratory tests, underlying diseases and concomitant medications. While the mean daily dose of CaC in the AR + CaC group (2.5 ± 1.3 g/day) tended to be higher than that in the CaC group (1.9 ± 1.1 g/day), the difference did not reach statistical significance (p = 0.062). When the CaC doses were compared between the CaC and AR + CaC groups for interdialysis intervals of 48 and 72 h separately, essentially similar results were obtained (data are not shown). No significant difference in the percentage of patients receiving vitamin D3 analogues was observed between the CaC and AR + CaC groups (p = 0.466). No significant differences were observed between two groups in biochemical data (including pre-HD creatinine and blood urea nitrogen) possibly related to hemodialysis conditions.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Hyperphosphatemia is one of the common complications in patients undergoing hemodialysis. Although calcium carbonate (CaC) is often used to control serum inorganic phosphorus level in dialysis patients, co-administration of gastric acid reducers (ARs) may interfere with the phosphate binding effect of CaC. We performed a retrospective medical chart review to study whether ARs attenuate the hypophosphatemic effect of CaC in patients undergoing hemodialysis.

Methods: One hundred and eight chronic hemodialysis patients receiving either CaC alone or CaC concomitant with one of the ARs (proton pump inhibitors and histamine H2-receptor antagonists) were retrieved from the medical charts in Juntendo University Nerima Hospital. The patients were subdivided according to the interval between hemodialysis sessions (interdialysis interval of 48 or 72 h). A multivariate analysis was performed to identify clinical covariates associated with the variability of serum inorganic phosphorus levels. The study protocol was approved by the Institutional Review Board before the study was begun.

Results: Among patients on hemodialysis with a 72-h interdialysis interval, the magnitude of increase in serum inorganic phosphorus concentration in patients receiving CaC and AR was significantly greater than in those receiving CaC alone. While a similar trend was observed among patients with a 48-h interdialysis interval, the difference did not reach a significant level. A multivariate regression analysis revealed that concomitant administration of ARs with CaC and a longer interdialysis interval (72 h) were significantly and independently associated with the magnitude of increase in serum phosphorus concentration between dialysis sessions. No significant differences in albumin-corrected serum calcium concentrations and incidence of pathological fractures were observed between patients receiving CaC alone and those receiving CaC with ARs.

Conclusions: Concomitant use of ARs with CaC may attenuate the hypophosphatemic effect of CaC in patients undergoing chronic hemodialysis. When hemodialysis patients require prescription of ARs for the prevention of upper gastrointestinal mucosal diseases (such as peptic ulcer), it may be prudent to choose a phosphate binder other than CaC.

No MeSH data available.