Elsevier

Kidney International

Volume 66, Supplement 90, September 2004, Pages S33-S38
Kidney International

Original Article
Treatment of hyperphosphatemia in patients with chronic kidney disease on maintenance hemodialysis: Results of the CARE study

https://doi.org/10.1111/j.1523-1755.2004.09006.xGet rights and content
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Treatment of hyperphosphatemia in patients with chronic kidney disease on maintenance hemodialysis: Results of the CARE study. Most patients with end-stage renal disease develop hyperphosphatemia because their dietary intake exceeds phosphorus elimination by intermittent thrice-weekly dialysis. Inadequately treated hyperphosphatemia plays a central role in the pathogenesis of secondary hyperparathyroidism and extraosseous calcification. Moreover, in the last 15 years, this biochemical abnormality has become increasingly important following the publication of two epidemiologic studies that demonstrated an association between elevated serum phosphorus and increased mortality risk in patients with end-stage renal disease. As a result, the National Kidney Foundation Kidney Disease Outcome and Quality Initiative (K/DOQI) Bone Metabolism and Chronic Kidney Disease Guidelines recommend that serum phosphorus levels be maintained between 3.5 and 5.5 mg/dL. Unfortunately, cross-sectional studies have shown a mean serum phosphorus of 6.2 mg/dL in the maintenance hemodialysis population in the United States. An alarming 60% of patients have serum phosphorus in excess of the 5.5 mg/dL level recommended by K/DOQI guidelines. In order to achieve this new target for serum phosphorus, the most efficacious and cost-effective phosphate binders currently available should be utilized. In this review, we discuss the results of the Calcium Acetate Renagel Evaluation (CARE study), which clearly demonstrated the superiority of calcium acetate over sevelamer hydrochloride for controlling serum phosphorus and calcium-phosphate product to the levels recommended by the K/DOQI guidelines.

KEYWORDS

sevelamer hydrochloride
calcium acetate
phosphate binder
hyperphosphatemia
calcium
calcium phosphorus product
chronic kidney disease

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