The effect of gastric acid suppression with pantoprazole on the efficacy of calcium carbonate as a phosphate binder in haemodialysis patients
Nephrology, 04/12/2012Cervelli MJ et al.
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.
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.
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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