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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.


Effects of different ARs on change in serum inorganic phosphorus concentration. Error bar indicates standard deviation. AR, acid reducer
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Fig4: Effects of different ARs on change in serum inorganic phosphorus concentration. Error bar indicates standard deviation. AR, acid reducer

Mentions: In the AR + CaC group, 73 and 12 patients were prescribed one of the PPIs (8 esomeprazole [20 mg/day], 33 lansoprazole [18 ± 6 mg/day], 20 omeprazole [20 ± 2 mg/day], and 12 rabeprazole [11 ± 3 mg/day]) and one of the H2RAs (10 famotidine [12 ± 4 mg/day], 2 ranitidine [150 mg/day]), respectively. No significant heterogeneity was observed regarding hemodialysis intervals (48 h vs 72 h) across different ARs (p = 0.101). Multiple comparisons showed no significant difference in the increase in serum inorganic phosphorus level during the interdialysis interval among the ARs examined, excluding ranitidine. Because only 2 patients were given ranitidine, these patients were excluded from comparison (Fig. 4).Fig. 4


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
Effects of different ARs on change in serum inorganic phosphorus concentration. Error bar indicates standard deviation. AR, acid reducer
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Effects of different ARs on change in serum inorganic phosphorus concentration. Error bar indicates standard deviation. AR, acid reducer
Mentions: In the AR + CaC group, 73 and 12 patients were prescribed one of the PPIs (8 esomeprazole [20 mg/day], 33 lansoprazole [18 ± 6 mg/day], 20 omeprazole [20 ± 2 mg/day], and 12 rabeprazole [11 ± 3 mg/day]) and one of the H2RAs (10 famotidine [12 ± 4 mg/day], 2 ranitidine [150 mg/day]), respectively. No significant heterogeneity was observed regarding hemodialysis intervals (48 h vs 72 h) across different ARs (p = 0.101). Multiple comparisons showed no significant difference in the increase in serum inorganic phosphorus level during the interdialysis interval among the ARs examined, excluding ranitidine. Because only 2 patients were given ranitidine, these patients were excluded from comparison (Fig. 4).Fig. 4

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.