Impact of oral calcium on mortality of dialysis patients

Impact of oral calcium on mortality of dialysis patients—an underestimated risk?
Juergen Bommer1,2, Markus Ketteler3 and Eberhard Ritz4
+ Author Affiliations

1University Heidelberg, Heidelberg, Germany
2Dialysis Center Heidelberg, Heidelberg, Germany
3Division of Nephrology, Klinikum Coburg GmbH, Coburg, Germany
4Department of Nephrology, University Heidelberg, Heidelberg, Germany
Correspondence and offprint requests to: Juergen Bommer; E-mail: juergen_bommer@t-online.de
Received December 22, 2011.
Accepted February 14, 2012.
Key words
calcification calcium haemodialysis phosphate phosphate binder

Phosphate is an accepted trigger and promoter of soft tissue calcification. Today, oral calcium-containing phosphate binders are still frequently administered to reduce hyperphosphataemia in patients with reduced renal function. There is, however, increasing evidence that a positive calcium balance and elevated serum calcium concentrations may aggravate soft tissue calcification. Some recent controlled [1, 2] trials as well as recent unpublished observational evidence from Dialysis Outcome and Practice Pattern Study (DOPPS) point to increased mortality in renal patients treated with calcium-containing P binders. Unfortunately, each of these studies has some methodological limitations. Nevertheless, a recent meta-analysis documented an increased risk of myocardial infarction and stroke even in patients without kidney disease when treated with calcium supplements [3].

Full article: http://ndt.oxfordjournals.org/content/early/2012/04/24/ndt.gfs077.full