Abstract
Hyperphosphatemia leading to hyperparathyroidism and ultimately renal osteodystrophy is a well-known complication of chronic renal failure. A new hydrogel binder, sevelamer, has recently become available for use in hyperphosphatemic patients with renal failure. We had previously mixed the capsule with pumped breast milk and formula, but discovered that the hydrogel formed a viscous solution that infants were unable or unwilling to swallow. We therefore evaluated the phosphorus content of fresh and frozen breast milk before and after treating with different doses of sevelamer at different temperatures and for varying lengths of time. The hydrogel bound promptly to phosphorus, reducing the phosphorus content 78% within 5 min. The viscous hydrogel settled to the bottom of the container within 10 min allowing the supernatant to be easily decanted. We also evaluated the breast milk for changes in other electrolytes, osmolality, pH, and macronutrient content. These results show that fresh or frozen breast milk can be safely pretreated with sevelamer without significantly changing its macronutrient or ionic content, with the exception of calcium and protein. The supernatant can be fed to infants or instilled through a gastrostomy tube without difficulty since the viscous hydrogel settles rapidly to the bottom of the container.
Similar content being viewed by others
References
Hsu CY, Chertow GM (2002) Elevations of serum phosphorus and potassium in mild to moderate chronic renal insufficiency. Nephrol Dial Transplant 17:1419–1425
Kent JC, Arthur PG, Retallack RW, Hartmann PE (1992) Calcium, phosphate, and citrate in human milk at initiation of lactation. J Dairy Res 59:161–167
Siberry GK, Iannone RI (eds) (2000) The Harriet Lane Handbook. Mosby, Missouri, p 500
Griswold WR, Reznik V, Mendoza SA, Trauner D, Alfrey AC (1983) Accumulation of aluminum in a nondialyzed uremic child receiving aluminum hydroxide. Pediatrics 71:56–58
Nathan E, Pedersen SE (1980) Dialysis encephalopathy in a non-dialysed uraemic boy treated with aluminium hydroxide orally. Acta Paediatr Scand 69:793–796
Salusky IB, Goodman WG (2002) Cardiovascular calcification in end-stage renal disease. Nephrol Dial Transplant 17:336–339
Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105
Chertow GM, Burke SK, Lazarus JM, Stenzel KH, Wombolt D, Goldberg D, Bonventre JV, Slatopolsky E (1997) Poly[allylamine hydrochloride] (RenaGel): a noncalcemic phosphate binder for the treatment of hyperphosphatemia in chronic renal failure. Am J Kidney Dis 29:66–71
Slatopolsky EA, Burke SK, Dillon MA (1999) RenaGel, a nonabsorbed calcium- and aluminum-free phosphate binder, lowers serum phosphorus and parathyroid hormone. The RenaGel Study Group. Kidney Int 55:299–307
Bunchman TE, Wood EG, Schenck MH, Weaver KA, Klein BL, Lynch RE (1991) Pretreatment of formula with sodium polystyrene sulfonate to reduce dietary potassium intake. Pediatr Nephrol 5:29–32
Hurley WL. Lactation biology at the University of Illinois Urbana-Champaign. Lecture on human milk and lactation,http://classes.aces.uiuc.edu/AnSci308/HumanLact.html.
Bleyer AJ, Burke SK, Dillon M, Garrett B, Kant KS, Lynch D, Rahman SN, Schoenfeld P, Teitelbaum I, Zeig S, Slatopolsky E (1999) A comparison of the calcium-free phosphate binder sevelamer hydrochloride with calcium acetate in the treatment of hyperphosphatemia in hemodialysis patients. Am J Kidney Dis 33:694–701
Schroder CH, Berg AM van den, Williems JL, Monnens LA (1993) Reduction of potassium in drinks by pre-treatment with calcium polystyrene sulphonate. Eur J Pediatr 152:263–264
Bonnet L, Goudable J, Accominotti M, Fontaine D, Cochat P (1997) Effect of ion exchange resins on the composition of milk (abstract). Nephrologie 18:287
Fassinger N, Dabbagh S, Mukhopadhyay S, Lee DY (1998) Mineral content of infant formula after treatment with sodium polystyrene sulfonate or calcium polystyrene sulfonate. Adv Perit Dial 14:274–277
Acknowledgement
The authors wish to thank Dr. John R. Petrocik for his assistance in the preparation of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Additional information
The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, D.C., Clinical Investigation Program, sponsored this report S03–014 as required by NSHSBETHINST 6000.41A. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government
Rights and permissions
About this article
Cite this article
Ferrara, E., Lemire, J., Reznik, V.M. et al. Dietary phosphorus reduction by pretreatment of human breast milk with sevelamer. Pediatr Nephrol 19, 775–779 (2004). https://doi.org/10.1007/s00467-004-1448-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-004-1448-6