Differences in gastrointestinal calcium absorption after the ingestion of calcium-free phosphate binders

Both calcium-containing and noncalcium-containing phosphate binders can increase gastrointestinal calcium absorption. Previously, we observed that lanthanum carbonate administration to rats with renal failure is not associated with increased calciuria. Additionally, lanthanum carbonate treatment in...

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Published in:American journal of physiology. Renal physiology 2014-01, Vol.306 (1), p.F61-F67
Main Authors: Behets, Geert J, Dams, Geert, Damment, Stephen J, Martin, Patrick, De Broe, Marc E, D'Haese, Patrick C
Format: Article
Language:English
Subjects:
Adult
Animals
Binding sites
Calcium
Calcium - metabolism
Carbamates - pharmacology
Cellulose - pharmacology
Chelating Agents - pharmacology
Digestive system
Female
Gastrointestinal Tract - physiology
Humans
Kidney diseases
Lanthanum - pharmacology
Male
Phosphates - chemistry
Phosphates - metabolism
Polyamines - pharmacology
Rats
Rats, Wistar
Renal Insufficiency, Chronic - metabolism
Rodents
Sevelamer
Young Adult
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Summary:Both calcium-containing and noncalcium-containing phosphate binders can increase gastrointestinal calcium absorption. Previously, we observed that lanthanum carbonate administration to rats with renal failure is not associated with increased calciuria. Additionally, lanthanum carbonate treatment in dialysis patients has been associated with a less pronounced initial decrease in serum parathyroid hormone compared with other phosphate binders. For 8 days, male Wistar rats received a diet supplemented with 2% lanthanum carbonate, 2% sevelamer, 2% calcium carbonate, or 2% cellulose. Calciuria was found to be increased in animals with normal renal function treated with sevelamer or calcium carbonate but not with lanthanum carbonate. In animals with renal failure, cumulative calcium excretion showed similar results. In rats with normal renal function, serum ionized calcium levels were increased after 2 days of treatment with sevelamer, while calcium carbonate showed a smaller increase. Lanthanum carbonate did not induce differences. In animals with renal failure, no differences were found between sevelamer-treated, calcium carbonate-treated, and control groups. Lanthanum carbonate, however, induced lower ionized calcium levels within 2 days of treatment. These results were confirmed in normal human volunteers, who showed lower net calcium absorption after a single dose of lanthanum carbonate compared with sevelamer carbonate. In conclusion, these two noncalcium-containing phosphate-binding agents showed a differential effect on gastrointestinal calcium absorption. These findings may help to improve the management of calcium balance in patients with renal failure, including concomitant use of vitamin D.
ISSN:1931-857X
1522-1466
DOI:10.1152/ajprenal.00219.2013