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Buffering Effects of Calcium Carbonate as Clarified by Sevelamer Hydrochloride Monotherapy
Author(s) -
Akatsuka Toshio,
Mochizuki Toshio,
Koike Takao
Publication year - 2008
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1744-9987.2008.00577.x
Subject(s) - sevelamer , medicine , calcium carbonate , calcium , hemodialysis , carbonate , metabolic acidosis , acidosis , hydrochloride , gastroenterology , hyperphosphatemia , chemistry , biochemistry , organic chemistry
This study was undertaken to examine the necessity of taking into account the acid–base balance to ensure safe switching from calcium carbonate to sevelamer hydrochloride in hemodialysis patients. Forty‐two hemodialysis patients were divided into two groups: the sevelamer hydrochloride therapy group ( n = 18; “monotherapy group”) and the combined calcium carbonate plus sevelamer hydrochloride therapy group ( n = 24; “combined therapy group”). Observation was continued for six months. Subsequently, treatment with calcium carbonate was resumed in the monotherapy group at a dose level equal to that used before the start of study, and the combined therapy group continued to receive combined calcium carbonate + sevelamer hydrochloride therapy for another six months. The monotherapy group showed marked metabolic acidosis (HCO 3 ‐ level from 20.2 ± 2.4 mmol/L to 17.7 ± 0.5 mmol/L). While the acidosis also became worse in the combined therapy group, the decrease in serum HCO 3 ‐ level was smaller in this group than in the monotherapy group. The monotherapy group showed rapid recovery from acidosis following resumption of calcium carbonate administration (HCO 3 ‐ level from 17.7 ± 0.5 mmol/L to 20.6 ± 0.7 mmol/L). We analyzed the cause of acidosis by the Stewart–Figge approach, and it was found to be attributable to the elevation of the serum Cl – level. The results suggest that treatment with calcium carbonate shows some buffering effects. Calcium carbonate acts as a potent alkalizing agent. We therefore consider it advisable to use sevelamer hydrochloride in combination with calcium carbonate in hemodialysis patients.