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Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Orally administered calcium carbonate tablets are commonly prescribed as a calcium supplement and for their phosphate-binding effects in renal failure patients. Two cases are reported in which a commercially available brand of calcium carbonate tablets appeared to be ineffective. Formal investigation of the bioavailability of this product revealed it to have impaired disintegration and dissolution and a lack of clinical efficacy. Recommendations that will enable physicians to avoid prescribing and pharmacists to avoid dispensing ineffective calcium carbonate tablets are proposed.
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PMID:Variable efficacy of calcium carbonate tablets. 259 73

Hyperphosphatemia and secondary hyperparathyroidism are regular complications in patients suffering from end-stage renal failure. Aluminum-containing drugs are widely used to control serum phosphate, but this therapy carries the well-known risk of aluminum toxicity. Previously we demonstrated that a mixture of ketoacids is very effective in lowering increased serum phosphate and serum PTH levels. Recent studies to clarify the underlying mechanisms whereby these compounds lower serum phosphate revealed that ketoacids act as intestinal phosphate binders. In balance studies we demonstrated that intestinal phosphorus uptake decreased in normal subjects (decrease of absorption during ingestion: 0.7-3.14 mmol/day). Additional in vitro studies not only confirmed the in vivo results but also showed that ketoacids are as efficient as calcium carbonate although they provide less calcium. It is of further interest that ketoacids reached their greatest binding efficiency when the pH is 7.0, whereas calcium carbonate binds phosphate predominantly when the pH is 2.0 or 5.0. Ketoacids represent a further therapy to lower serum phosphate in uremia. As they provide less calcium than calcium carbonate, they could be considered as an advantageous, less dangerous alternative.
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PMID:Calcium salts of ketoacids as a new treatment strategy for uremic hyperphosphatemia. 263 49

To investigate the effect of phosphate binders on the progress of renal functional deterioration, aluminium hydroxide (AL) or calcium carbonate (CA) was administered to adriamycin (ADR)-induced progressive renal failure model rats. Urinary protein excretion was reduced in ADR rats treated with AL (ADR-AL group) or CA (ADR-CA group), compared to those without the treatment (ADR group). Urinary phosphate excretion, serum phosphate concentration, and calcium-phosphate product were significantly lower in the ADR-AL and ADR-CA groups than in the ADR group. At week 34, increased serum creatinine, glomerular sclerosis and tubulointerstitial alterations, being marked in the ADR group, were ameliorated in the ADR-AL and ADR-CA groups. However, there was no significant difference in body weight and serum total protein among the three groups. We conclude that AL and CA could both prevent chronic progressive renal deterioration in focal glomerular sclerosis induced by ADR, and preserve the nutritional condition.
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PMID:Effect of phosphate binders on the course of chronic renal failure in rats with focal glomerular sclerosis. 278 1

Peritoneal dialysis (PD) does not demand special equipment and its fluid composition can be easily changed according to the individual condition. Nine patients with chronic or acute renal failure presented severe metabolic alkalosis (MA). Hemodialysis (HD) proved virtually ineffective and the MA persisted. Physiological saline solution was adopted as the main component of the PD fluid for the treatment of MA. By this method, Cl- can be shifted from PD fluid to extracellular fluid (ECF) and HCO3- from ECF to PD fluid by ionic gradient. Therefore, pH and base excess (BE) of these patients both improved to the normal range after several fluid exchanges. The lowering effect of BE (delta BE/L) ranged from 0.99 to 2.6. Hyposaline and normo-osmol solution (Na+ 70 mEq/L) were used for one patient with hypernatremia and consciousness disturbance. Serum (S)-Na decreased from 170 to 138 mEq/L, and consciousness became almost clear with the use of 15 L of PD fluid. Hypersaline solution (Na+ 190 mEq/L) was used for two patients with hyponatremia (S-Na 113 and 121 mEq/L). S-Na rose to within the normal range after 16 and 9 L in the two cases. A fluid mixed with distilled water, 10% NaCl and 7% NaHCO3 (HCO3 34-68 mEq/L) was used to treat lactic acidosis in two patients. By this method, HCO3- can be shifted from PD fluid to ECF and lactic acid from ECF to PD fluid. Two patients recovered from prolonged shock, and pH was corrected by 10 L and 4 L, respectively. PD should be considered for application in other diseases besides renal failure.
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PMID:Peritoneal dialysis as therapy for electrolyte and acid base disorders. 280 88

We report a case of a calcium phosphate bezoar resulting in colonic intussusception in a boy with chronic renal failure who received calcium carbonate to control hyperphosphatemia. Because of concerns about aluminum-related disease in patients receiving aluminum hydroxide phosphate binders, calcium carbonate is being used more frequently to manage phosphate retention in renal failure. The development of bezoars may complicate this new form of therapy.
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PMID:Colonic intussusception secondary to a calcium phosphate bezoar in a child receiving calcium carbonate for hyperphosphatemia. 280 98

Antacids used to decrease phosphorus absorption in patients with renal failure may be toxic. To find more efficient or less toxic binders, a three-part study was conducted. First, theoretical calculations showed that phosphorus binding occurs in the following order of avidity: Al3+ greater than H+ greater than Ca2+ greater than Mg2+. In the presence of acid (as in the stomach), aluminum can therefore bind phosphorus better than calcium or magnesium. Second, in vitro studies showed that the time required to reach equilibrium varied from 10 min to 3 wk among different compounds, depending upon solubility in acid and neutral solutions. Third, the relative order of effectiveness of binders in vivo was accurately predicted from theoretical and in vitro results; specifically, calcium acetate and aluminum carbonate gel were superior to calcium carbonate or calcium citrate in inhibiting dietary phosphorus absorption in normal subjects. We concluded that: (a) inhibition of phosphorus absorption by binders involves a complex interplay between chemical reactions and ion transport processes in the stomach and small intestine; (b) theoretical and in vitro studies can identify potentially better in vivo phosphorus binders; and (c) calcium acetate, not previously used for medical purposes, is approximately as efficient as aluminum carbonate gel and more efficient as a phosphorus binder than other currently used calcium salts.
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PMID:Reduction of dietary phosphorus absorption by phosphorus binders. A theoretical, in vitro, and in vivo study. 291 Sep 21

Renal failure is frequently associated with osteodystrophia due to secondary hyperparathyreoidism and/or increased aluminum intake. The problem of hypercalcemia and hyperphosphatemia can more easily controlled by CAPD than by hemodialysis. Total serum and ionized calcium levels are rapidly normalized by a CAPD regime of four 2-1 exchanges with 1.75 mmol/l Ca. Under the same CAPD regime 250-300 mg phosphate are removed per day. Depending on the ingestion of phosphate, 100-200 mg phosphate per day remain to be removed by phosphate binding agents. Since the main source of aluminum in CAPD patients is oral ingestion of aluminum-containing phosphate binders, serum levels should be regulated by diet and calcium carbonate. To suppress PTH secretion serum ionized calcium levels need to be maintained at the upper limit of normal. This can also be achieved by the use of oral calcium carbonate. Vitamin D or analogs should be prescribed only when clinically indicated by persistent hypocalcemia, osteitis fibrosa or non-aluminum related osteomalacia.
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PMID:Renal osteodystrophy and aluminum bone disease in CAPD patients. 305 62

In this retrospective study, 287 patients with acute renal failure observed between 1980 and 1985 were divided into 2 groups, according to age: group 1 of 65 years or more (n = 100) and group 2 between 17 and 64 years (n = 187). In both age groups the whole spectrum of causes of acute renal failure was found, but within that spectrum a higher incidence of post-renal failure, acute renal vascular disease and of hypovolaemic acute renal failure was noted in group 1 versus group 2. On the other hand, pigment-induced acute renal failure was lower in group 1 (4%) versus group 2 (13%). The overall survival was 54% in the elderly versus 56% in the younger patients (NS). A close relationship between survival and the number of postadmission complications was found in both groups. Interestingly, the presence of severe hypokalaemia (less than 3.5 mmol/l) and metabolic alkalosis (plasma HCO3 greater than 30 mmol/l) was associated with a very high mortality of 73% and 86% respectively in the elderly patients. Complete or incomplete recovery of renal function was the same in both age groups. It is concluded that age alone should not be used as a discriminating factor in therapeutic decisions concerning acute renal failure in an older patient.
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PMID:Causes and prognosis of acute renal failure in elderly patients. 312 8

High voltage electric current was passed through oyster shell powder for electrolysis. The crystalline shape of oyster shell electrolysate appeared to be quite different from that of CaO or CaCO3. Higher serum calcium values were achieved by oral administration of the same amount of as oyster shell electrolysate than as calcium carbonate in vitamin D-deficient rats, suggesting a better intestinal absorption of the former than the latter. In four patients with postoperative hypoparathyroidism with reduced intestinal calcium absorption, the same amount of elementary calcium as oyster shell electrolysate was more effective than calcium carbonate in raising serum calcium in the absence of vitamin D supplement. Oyster shell electrolysate was also more effective in suppressing serum parathyroid hormone concentration than calcium carbonate in two patients with secondary hyperparathyroidism with renal failure. Calcium thus appears to be more readily absorbed from oyster shell electrolysate than from calcium carbonate through intestinal barriers produced by insufficient vitamin D action.
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PMID:Intestinal absorption of oyster shell electrolysate. 319 Dec 87

Therapy with orally administered calcitriol often does not adequately control the biochemical manifestations of secondary hyperparathyroidism in uremic patients. This may be due to inadequate serum concentrations of 1.25(OH)2 vitamin D and/or to insufficient dietary calcium supplementation. In the present study, therefore, we examined the effect on parathyroid function of calcitriol and calcium carbonate, administered orally, in doses sufficient to normalize the serum 1.25(OH)2 vitamin D and calcium concentrations. After nine months of combined therapy, marked suppression of immunoreactive PTH occurred in the absence of hypercalcemia. Furthermore, prolonged therapy resulted in additional suppression of the PTH concentrations comparable in magnitude to that reported following intravenous calcitriol therapy and was associated with a mild degree of hypercalcemia similar to that which occurs with intravenous therapy. Euparathyroidism was achieved in 25% of the patients by 15 months of treatment. In conclusion, secondary hyperparathyroidism can be effectively controlled with combined oral therapy without significant hypercalcemia in selected patients with end-stage renal failure. This salutary effect may result from direct actions of 1.25(OH)2D on the parathyroid gland and/or gastrointestinal tract, or from an overall action of combined treatment to restore calcium homeostasis.
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PMID:Oral calcitriol and calcium: efficient therapy for uremic hyperparathyroidism. 321 May 46


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