Abstract
Forty-five children with stable chronic renal failure, not on dialysis, were treated conservatively with a regimen of mild dietary phosphate restriction and high-dose phosphate binders for up to 5 years. Both aluminum hydroxide and calcium carbonate were used initially, but almost all patients were taking calcium carbonate towards the end of the period. Serum immunoreactive parathyroid hormone concentrations were significantly decreased and were within the normal range after 1 year and remained normal during treatment. There was no significant change in renal function over the same treatment period. We conclude that calcium carbonate should be used as the phosphate binder of choice in the long-term suppression of hyperphosphatemia and hyperparathyroidism in uremic children.
Similar content being viewed by others
References
Slatopolsky E, Rutherford WE, Hruska K, Martin K, Klahr S (1978) How important is phosphate in the pathogenesis of renal osteodystrophy? Arch Intern Med 138: 848–852
Slatopolsky E, Caglar S, Penell JP, Taggart DD, Canterbury JM, Reiss E, Bricker NS (1971) On the pathogenesis of hyperparathyroidism in chronic experimental renal insufficiency in the dog. J Clin Invest 50: 492–499
Slatopolsky E, Caglar S, Gradowska J, Canterbury JM, Reiss E, Bricker NS (1972) On the prevention of secondary hyperparathyroidism in experimental chronic renal disease using proportional reduction of dietary phosphorus intake. Kidney Int 2: 147–152
Kaplan MA, Canterbury JM, Bourgoignie JJ, Veliz G, Gavellas G, Reiss E, Bricker NS (1979) Reversal of hyperparathyroidism in response to dietary phosphorus restriction in the uremic dog. Kidney Int 15: 43–48
Andreoli SP, Bergstein JM, Sherrand DJ (1984) Aluminum intoxication from aluminum containing phosphate binders in children with azotemia not undergoing hemodialysis. N Engl J Med 310: 1079–1084
Sedman AB, Miller NL, Warady BA, Lunn GM, Alfrey AC (1984) Aluminum loading in children with chronic renal failure. Kidney Int 26: 201–204
Clarkson EM, McDonald SJ, De Wardener HJ (1966) The effect of a high intake of calcium carbonate in normal subjects and patients with chronic renal failure. Clin Sci 30: 425–438
Moriniere PH, Roussel A, Tahiri Y, de Fremont JF, Mautel G, Jandon MC, Gueris J, Fournier A (1982) Substitution of aluminum hydroxide by high doses of calcium carbonate in patients on chronic hemodialysis: disappearance of hyperaluminaemia and equal control of hyperparathyroidism. Proc Eur Dial Transplant Assoc 19: 784–787
Mak RHK, Turner C, Thompson T, Powell H, Haycock GB, Chantler C (1985) Suppression of secondary hyperparathyroidism in children with chronic renal failure by high dose phosphate binders: calcium carbonate versus aluminum hydroxide. Br Med J 291: 623–627
Woo J, Singer FR (1974) Radioimmunoassay for human parathyroid hormone. Clin Chim Acta 54: 161–168
Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58: 259–263
Llach F, Massry S (1985) On the mechanism of secondary hyperparathyroidism in moderate renal insufficiency. J Clin Endocrinol Metab 61: 601–606
Portale AA, Booth BE, Halloran BP, Curtis Morris R Jr (1984) Effect of dietary phosphorus on circulating concentrations of 1,25 dihydroxy vitamin D and immuno reactive parathyroid hormone in children with moderate renal insufficiency. J Clin Invest 73: 1580–1589
Llach F, Massry SG, Koffler A, Malluche HH, Singer FR, Brickman AS, Kurokawa K (1977) Secondary hyperparathyroidism in early renal failure: role of phosphate retention (abstract). Clin Res 25: 507A
Biswas CK, Arze RS, Ramos JM, Ward MK, Dewar JH, Kerr DN, Kenward DH (1982) Effect of aluminum hydroxide on serum ionised calcium, immunoreactive parathyroid hormone and aluminum in chronic renal failure. Br Med J 284: 776–778
Brown EM, Wilson RE, Eastman RC, Pallotta J, Marynick S (1982) Abnormal regulation of parathyroid hormone release by calcium in secondary hyperparathyroidism due to chronic renal failure. J Clin Endocrinol Metab 84: 172–179
Alfrey AC, Legendre GR, Kaehny WD (1976) The dialysis encephalopathy syndrome. Possible aluminum intoxication. N Engl J Med 294: 184–188
Ward MK, Ellis HA, Feest TG, Parkinson IS, Kerr DN (1978) Osteomalacic dialysis osteodystrophy: evidence for a water-borne aetiological agent, probably aluminum. Lancet I: 841–845
Short AK, Winney RJ, Robson JS (1980) Reversible microcytic hypochromic anaemia in dialysis patients due to aluminum intoxication. Proc Eur Dial Transplant Assoc 17: 226–233
Chan JCM, Kodroff MB, Lanwehr DM (1981) Effects of 1,25 dihyroxy vitamin D3 on renal function, mineral status and growth of children with severe chronic renal failure. Pediatrics 68: 559–566
Tougaard LE, Sorenson E, Brochner-Mortensen J, Christensen MS, Rodbro P, Sorensen AWS (1976) Controlled trial of 1-alpha-hydroxycholecalciferol in chronic renal failure. Lancet I: 1044–1048
Christiansen C, Rodbro P, Christensen MS, Hartnack B, Transbol I (1978) Deterioration of renal function during treatment of chronic renal failure with 1,25 dihydroxycholecalciferol. Lancet II: 700–703
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tamanaha, K., Mak, R.H.K., Rigden, S.P.A. et al. Long-term suppression of hyperparathyroidism by phosphate binders in uremic children. Pediatr Nephrol 1, 145–149 (1987). https://doi.org/10.1007/BF00849285
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00849285