The effect of gastric acid suppression with pantoprazole on the efficacy of calcium carbonate as a phosphate binder in haemodialysis patients

Nephrology, 04/12/2012

The results demonstrate clinical evidence for an adverse effect of gastric acid suppression on the effectiveness of calcium carbonate phosphate binders. Given their frequent co–prescription, this interaction may be a minor but common reason why some patients fail to control hyperphosphataemia. Clinicians should regularly assess the need for acid suppressants.

Methods

  • The study had 2 parts; a cross-sectional study (n=67), and an interventional, crossover, double-blind, randomised, placebo controlled trial in 26 patients given pantoprazole 40mg daily or placebo for two consecutive 6-week periods.

Results

  • The cross-sectional study showed no difference between those on and off acid suppressants in phosphate (1.43 ± 0.45 vs. 1.46 ± 0.31 mmol/l p = 0.782) or other parameters except age (72.2 ± 9.8 vs. 63.8 ± 14.8 yrs, p = 0.01).
  • In the interventional study, phosphate was higher during pantoprazole than placebo (1.59 ± 0.3 vs. 1.42 ± 0.3 mmol/l, p = 0.005).
  • Serum calcium (2.37 ± 0.2 vs. 2.46 ± 0.2 mmol/l, p = 0.012) and ionised calcium (1.17 ± 0.1 vs. 1.22 ± 0.1 mmol/l, p = 0.013) were lower during pantoprazole treatment. CaxPO4 (3.76 ± 0.7 vs. 3.48 ± 0.7 mmol2/l2, p = 0.032) and iPTH (31.9 ± 21.4 vs. 23.6 ± 17.7 pmol/l, p = 0.004) were higher on pantoprazole.

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