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Vol. 34. Núm. 5.Septiembre 2014
Páginas 545-692
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Vol. 34. Núm. 5.Septiembre 2014
Páginas 545-692
DOI: 10.3265/Nefrologia.pre2014.Jul.12527
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Efectos del acetato cálcico/carbonato magnésico en el tratamiento de la hiperfosfatemia en pacientes en diálisis en la práctica clínica real. Seguimiento durante un año
Effect of calcium acetate/magnesium carbonate in the treatment of hyperphosphataemia in dialysis patients in real clinical practice. One year follow up
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Ángel L.M. de Franciscoa, Lara Belmara, Celestino Piñeraa, María Kislikovaa, Miguel Serasa, Mara Serranoa, Zoila Albinesa, Cristina Sangoa, Manuel Ariasa
a Servicio de Nefrolog??a, Hospital Universitario Marqu??s de Valdecilla, Santander, Cantabria,
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Antecedentes: Este estudio observacional se llevó a cabo para investigar el uso y la efectividad, en la práctica clínica real, del acetato cálcico/carbonato magnésico (CaMg) en el tratamiento de la hiperfosfatemia en pacientes en diálisis. Métodos: Se realizó un seguimiento durante 3-12 meses en 120 pacientes adultos con enfermedad crónica renal en tratamiento con diálisis que recibían monotratamiento con CaMg o en combinación con otros quelantes del fósforo. Se midieron en suero los valores de fósforo, calcio, magnesio, hormona paratiroidea y concentración de albúmina a nivel basal y tras 3, 6 y 12 meses, respectivamente. Además, se documentó la dosis de CaMg, el uso de quelantes de fósforo concomitantes, la vitamina D y el cinacalcet. Los pacientes se dividieron en 2 subgrupos: aquellos a los que solo se les administraba CaMg (n=79) frente a los que recibían CaMg y un quelante de fósforo concomitante (n=41). Resultados: En ambos subgrupos, los niveles de fósforo sérico disminuyeron de forma significativa, con respecto a los basales, a los 3, 6 y 12 meses de tratamiento con CaMg. El porcentaje de logro de los niveles recomendados de fósforo sérico mejoró tras iniciar el tratamiento con CaMg. El mes 6, un total del 78% se encontraba dentro de las recomendaciones objetivo de Calidad de los Resultados de la Insuficiencia Renal (K/DOQI). El calcio sérico total corregido aumentó durante el tratamiento con CaMg, pero superaba levemente los límites superiores normales solo en tres pacientes. Asimismo, se observaron incrementos significativos del magnesio asintomáticos (P<0,001) en el grupo de monoterapia a los 3, 6 y 12 meses. Un total de 80 pacientes (67%) sufrieron episodios de hipermagnesemia leve (>2,6 mg/mL, 1,05 mmol/L). Conclusiones: El presente análisis de la práctica clínica habitual, en consonancia con los datos obtenidos de un ensayo aleatorizado controlado, demuestra que el tratamiento con CaMg mejora de forma considerable los niveles de fósforo sérico y ayuda a los pacientes a conseguir los objetivos K/DOQI y KDIGO (mejora de los resultados globales en la enfermedad renal).

Palabras clave:
Acetato cálcico/carbonato magnésico
Palabras clave:
Hiperfosfatemia
Palabras clave:
Diálisis
Palabras clave:
Quelante de fósforo

Background: This observational study was conducted to investigate the use and effectiveness of calcium acetate/magnesium carbonate (CaMg) in the treatment of hyperphosphataemia in dialysis patients in real-world clinical practice. Methods: 120 adult CKD patients on dialysis who received CaMg alone or in combination with other phosphate binders were followed-up for 3-12 months. Serum phosphorus, calcium, magnesium, parathyroid hormone and albumin concentration was measured at baseline and after 3, 6 and 12 months respectively. In addition, CaMg dosage, use of concurrent phosphate binders, vitamin D and cinacalcet was documented. Patients were evaluated in 2 subgroups – CaMg alone (n=79) vs. CaMg + concurrent phosphate binder (n=41). Results: In both subgroups serum phosphorus levels decreased significantly from baseline at 3, 6 and 12 months of CaMg treatment. The percentage achievement of recommended serum phosphorus targets improved after CaMg initiation. At month 6, a total of 78% were within the Kidney Disease Outcomes Quality Initiative (K/DOQI) target range. Total corrected serum calcium increased during CaMg treatment, but mildly exceeded the upper limit of normal in three patients only. Asymptomatic significant increases in magnesium (p<0.001) were observed in the monotherapy group at 3, 6 and 12 months. A total of 80 patients (67%) experienced episodes of mild hypermagnesaemia (>2.6mg/mL, 1.05mmol/L). Conclusions: This analysis of current clinical practice shows that – consistent with findings from a randomised controlled trial – CaMg treatment leads to marked improvement in serum phosphorus levels, helping patients in trying to achieve K/DOQI and KDIGO (Kidney Disease Improving Global Outcome) targets.

Keywords:
Calcium acetate/magnesium carbonate
Keywords:
Hyperphosphataemia
Keywords:
Dialysis
Keywords:
Phosphate binder
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Bibliografía
[1]
Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998;31:607-17. [Pubmed]
[2]
Floege J, Kim J, Ireland E, Chazot C, Drueke T, de Francisco A, et al. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant 2011;26:1948-55. [Pubmed]
[3]
Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med 2010;362(14):1312-24. [Pubmed]
[4]
Friedman EA. Calcium-based phosphate binders are appropriate in chronic renal failure. Clin J Am Soc Nephrol 2006;1:704-9. [Pubmed]
[5]
Qunibi WY, Hootkins RE, McDowell LL, Meyer MS, Simon M, Garza RO, et al. Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study). Kidney Int 2004;65:1914-26. [Pubmed]
[6]
Qunibi WY, Moustafa M, Muenz LR, He DY, Kessler PD, Diaz-Buxo JA, et al. A 1-year randomized trial of calcium acetate versus sevelamer on progression of coronary artery calcification in hemodialysis patients with comparable lipid control: the Calcium Acetate Renagel Evaluation-2 (CARE-2) study. Am J Kidney Dis 2008;51:952-65. [Pubmed]
[7]
Ring T, Nielsen C, Andersen SP, Behrens JK, Sodemann B, Kornerup HJ. Calcium acetate versus calcium carbonate as phosphorus binders in patients on chronic haemodialysis: a controlled study. Nephrol Dial Transplant 1993;8:341-6. [Pubmed]
[8]
Schaefer K, Scheer J, Asmus G, Umlauf E, Hagemann J, von Herrath D. The treatment of uraemic hyperphosphataemia with calcium acetate and calcium carbonate: a comparative study. Nephrol Dial Transplant 1991;6:170-5. [Pubmed]
[9]
Delmez JA, Tindira CA, Windus DW, Norwood KY, Giles KS, Nighswander TL, et al. Calcium acetate as a phosphorus binder in hemodialysis patients. J Am Soc Nephrol 1992;3:96-102. [Pubmed]
[10]
Delmez JA, Kelber J, Norword KY, Giles KS, Slatopolsky E. Magnesium carbonate as a phosphorus binder: a prospective, controlled, crossover study. Kidney Int 1996;49:163-7. [Pubmed]
[11]
Spiegel DM, Farmer B, Smits G, Chonchol M. Magnesium carbonate is an effective phosphate binder for chronic hemodialysis patients: a pilot study. J Ren Nutr 2007;17:416-22. [Pubmed]
[12]
Spiegel DM. The role of magnesium binders in chronic kidney disease. Semin Dial 2007;20:333-6. [Pubmed]
[13]
Spiegel DM, Farmer B. Long-term effects of magnesium carbonate on coronary artery calcification and bone mineral density in hemodialysis patients: A pilot study. Hemodial Int 2009;13:453-59.
[14]
Tzanakis IP, Papadaki AN, Wei M, Kagia S, Spadidakis VV, Kallivretakis NE, et al. Magnesium carbonate for phosphate control in patients on hemodialysis. A randomized controlled trial. Int Urol Nephrol 2008;40:193-201. [Pubmed]
[15]
Deuber HJ. Long-term efficacy and safety of an oral phosphate binder containing both calcium acetate and magnesium carbonate in hemodialysis patients. Nieren-und Hochdruckkrankheiten 2004;33:403-8.
[16]
de Francisco AL, Leidig M, Covic AC, Ketteler M, Benedyk-Lorens E, Mircescu GM, et al. Evaluation of calcium acetate/magnesium carbonate as a phosphate binder compared with sevelamer hydrochloride in haemodialysis patients: a controlled randomized study (CALMAG study) assessing efficacy and tolerability. Nephrol Dial Transplant 2010;25:3707-17. [Pubmed]
[17]
Ure??a P, Jacobson SH, Zitt E, Vervloet M, Malberti F, Ashman N, et al. Cinacalcet and achievement of the NKF/K-DOQI recommended target values for bone and mineral metabolism in real-world clinical practice--the ECHO observational study. Nephrol Dial Transplant 2009;24(9):2852-9. [Pubmed]
[18]
National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(Suppl 3):S1-S202.
[19]
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int ??Suppl 2009;(113):S1-S130.
[20]
Al Aly Z, Gonz??lez EA, Martin KJ, Gellens ME. Achieving K/DOQI laboratory target values for bone and mineral metabolism: an uphill battle. Am J Nephrol 2004;24:422-6. [Pubmed]
[21]
Lorenzo V, Martin-Malo A, Perez-Garcia R, Torregrosa JV, Vega N, de Francisco AL, et al. Prevalence, clinical correlates and therapy cost of mineral abnormalities among haemodialysis patients: a cross-sectional multicentre study. Nephrol Dial Transplant 2006;21(2):459-65.
[22]
Geiger H, Wanner C. Magnesium in disease. Clin Kidney J 2012;5(Suppl 1):i25-i38.
[23]
Khan AM, Lubitz SA, Sullivan LM, Sun JX, Levy D, Vasan RS, et al. Low serum magnesium and the development of atrial fibrillation in the community: the Framingham Heart Study. Circulation 2013;127(1):33-8. [Pubmed]
[24]
Zimmerman D, Sood MM, Rigatto C, Holden RM, Hiremath S, Clase CM. Systematic review and meta-analysis of incidence, prevalence and outcomes of atrial fibrillation in patients on dialysis. Nephrol Dial Transplant 2012;27(10):3816-22. [Pubmed]
[25]
Massy ZA, Dr??eke TB. Magnesium and outcomes in patients with chronic kidney disease: focus on vascular calcification, atherosclerosis and survival. Clin Kidney J 2012;5(Suppl 1):i52-i61.
[26]
Navarro-Gonzalez JF, Mora-Fernandez C, Garcia-Perez J. Clinical implications of disordered magnesium homeostasis in chronic renal failure and dialysis. Semin Dial 2009;22:37-44. [Pubmed]
[27]
Covic A, Passlick-Deetjen J, Kroczak M, B??schges-Seraphin B, Ghenu A, Ponce P, et al. A comparison of calcium acetate/magnesium carbonate and sevelamer-hydrochloride effects on fibroblast growth factor-23 and bone markers: post hoc evaluation from a controlled, randomized study. Nephrol Dial Transplant 2013;28(9):2383-92. [Pubmed]
[28]
Cunningham J, Rodr??guez M, Messa P. Magnesium in chronic kidney disease Stages 3 and 4 and in dialysis patients. Clin Kidney J 2012;5(Suppl 1):i39-i51.
[29]
Plagemann T, Prenzler A, Mittendorf T. Considerations about the effectiveness and cost effectiveness of therapies in the treatment of hyperphosphataemia. Health Econ Rev 2011;1(1):1. [Pubmed]
[30]
De Francisco ALM, Rodriguez M. Magnesium ?? its role in CKD. Nefrologia 2013;33(3):389-99. [Pubmed]
[31]
Jamal SA, Vandermeer B, Raggi P, Mendelssohn DC, Chatterley T, Dorgan M, et al. Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Lancet 2013;382(9900):1268-77. [Pubmed]
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