In the present study, a comparative evaluation of the effects of
calcium acetate,
calcium carbonate,
sevelamer hydrochloride and
lanthanum carbonate was carried out in 120 patients with
end stage kidney disease (ESKD) undergoing
hemodialysis. Biochemical parameters, like serum phosphorous, serum
calcium and serum
alkaline phosphatase level and intact
parathyroid hormone level, were measured. A statistically significant reduction in serum phosphorous, serum
calcium,
calcium × phosphorous and serum
alkaline phosphatase level were observed with all
phosphate binders during 3 months of treatment. Reduction in serum phosphorous were observed with
calcium acetate (1.5 mg/dL),
calcium carbonate (1.3 mg/dL),
sevelamer hydrochloride (2.1 mg/dL) and
lanthanum carbonate (1.79 mg/dL). The reduction of serum
alkaline phosphatase was observed more commonly with
sevelamer (107.37 IU/L) and
lanthanum (104.33 IU/L) treatments than with
calcium acetate (93.9 IU/L) and
calcium carbonate (86.57 IU/L). There was no statistically significant change in serum
calcium observed with
sevelamer and
lanthanum treatments, while
calcium-based
phosphate binders caused a significant rise in the serum
calcium level. Serum intact
parathyroid hormone level was significantly reduced with all
phosphate binder treatments. This decline was highest with
sevelamer and lowest with
calcium carbonate. All treatments were well tolerated and safety profiles were consistent with previous reports in
hemodialysis patients. It is concluded that all
phosphate binders are safe and effective for the treatment of
hyperphosphatemia in patients with ESKD undergoing
hemodialysis. However,
sevelamer hydrochloride seems to be superior among all with lowering incidence of
hypercalcemia.