Differential effects of phosphate binders on vitamin D metabolism in chronic kidney disease. Issue 4 (11th March 2020)

• Record Type: Journal Article
• Authors: Ginsberg, Charles; Zelnick, Leila R; Block, Geoffrey A; Chertow, Glenn M; Chonchol, Michel; Hoofnagle, Andrew; Kestenbaum, Bryan; de Boer, Ian H
• Is Part Of: Nephrology dialysis transplantation. Volume 35:Issue 4(2020)
• Page Start: 616
• Page End: 623
• Publication Date: 2020-03-11
• Subjects: chronic renal insufficiency -- CKD-MBD -- mineral metabolism -- phosphate binders -- vitamin D; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfaa010
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background: Phosphate binders are commonly used in the treatment of patients with hyperphosphatemia. While phosphate binders are used to lower phosphate, the effects of specific phosphate binder types on vitamin D metabolism are unknown. Methods: We performed a secondary analysis of the Phosphate Normalization Trial in which patients with moderate to advanced chronic kidney disease were randomized to receive either placebo, sevelamer carbonate, lanthanum carbonate or calcium acetate for 9 months. We evaluated changes in serum concentrations of vitamin D metabolites including 24, 25-dihydroxyvitamin D3 [24, 25(OH)2 D3 ], 1, 25-dihydroxyvitamin D3 [1, 25(OH)2 D3 ], the ratio of 24, 25(OH)2 D3 to 25-hydroxyvitamin D [the vitamin D metabolite ratio (VMR)] and the ratio of serum 1, 25(OH)2 D to 25-hydroxyvitamin D. Results: Compared with placebo, randomization to the calcium acetate arm was associated with a 0.6 ng/mL (95% CI 0.2, 1) and 13.5 pg/ng (95% CI 5.5, 21.5) increase in 24, 25(OH)2 D and VMR, respectively, and a 5.2 pg/mL (95% CI 1.1, 9.4) reduction in 1, 25(OH)2 D. Randomization to sevelamer carbonate was associated with a 0.5 ng/mL (95% CI −0.9, −0.1) and 11.8 pg/ng (95% CI −20, −3.5) reduction in 24, 25(OH)2 D3 and VMR, respectively. There was no association of the sevelamer arm with the change in 1, 25(OH)2 D3, and randomization to lanthanum carbonate was not associated with a change in any of the vitamin D metabolites. Conclusion: Administration of different phosphate binders to patients with moderate to severe CKD results in unique changes in vitamin D metabolism. Graphical Abstract: