Document Detail

Effect of gastric acid suppression with pantoprazole on the efficacy of sevelamer hydrochloride as a phosphate binder in haemodialysis patients: a pilot study.
MedLine Citation:
PMID:  22329674     Owner:  NLM     Status:  MEDLINE    
Sevelamer hydrochloride (HCL) is thought to require an appropriately acidic environment in order to bind gastrointestinal phosphate. Changes in gastric acidity with acid suppressants may therefore alter the efficacy of sevelamer HCL. Given the widespread use of acid suppression therapy in chronic kidney disease patients, there is potential for a common significant drug interaction to occur. This pilot study evaluated the in vivo effect of gastric acid suppression with pantoprazole on the efficacy of sevelamer HCL as a phosphate binder in maintenance haemodialysis patients. The study protocol was a cross-over, double-blinded, randomized, placebo-controlled trial in 10 haemodialysis patients randomly assigned to pantoprazole 40 mg daily or placebo for two consecutive 6-week periods. Serum phosphate was not significantly altered during pantoprazole compared with placebo treatment (1.61 ± 0.45 mmol/L vs 1.76 ± 0.42 mmol/L, P = 0.204). There were no differences in serum calcium, parathyroid hormone and bicarbonate. This pilot study demonstrates preliminary in vivo evidence for no effect of gastric acid suppression on the effectiveness of sevelamer HCL. Our results are limited by small sample size and therefore, larger experimental studies should be conducted. Although our study did not find a significant drug interaction, given the high prevalence of acid suppressant use in dialysis patients, physicians should be aware of the potential influence of acid suppression on the efficacy of phosphate binders and regularly assess the clinical need for acid suppression therapy.
Beryl Lai; Matthew J Cervelli
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Nephrology (Carlton, Vic.)     Volume:  17     ISSN:  1440-1797     ISO Abbreviation:  Nephrology (Carlton)     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-18     Completed Date:  2012-08-13     Revised Date:  2013-06-04    
Medline Journal Info:
Nlm Unique ID:  9615568     Medline TA:  Nephrology (Carlton)     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  402-6     Citation Subset:  IM    
Copyright Information:
© 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.
Department of Pharmacy, The Queen Elizabeth Hospital School of Pharmacy, University of South Australia, Australia.
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MeSH Terms
2-Pyridinylmethylsulfinylbenzimidazoles / therapeutic use*
Biological Markers / blood
Chelating Agents / therapeutic use*
Cross-Over Studies
Double-Blind Method
Gastric Acid / secretion*
Gastric Mucosa / drug effects*,  secretion
Hydrogen-Ion Concentration
Hyperphosphatemia / blood,  drug therapy*,  etiology
Kidney Diseases / blood,  complications,  therapy*
Middle Aged
Phosphates / blood
Pilot Projects
Polyamines / therapeutic use*
Proton Pump Inhibitors / therapeutic use*
Renal Dialysis* / adverse effects
South Australia
Time Factors
Treatment Outcome
Reg. No./Substance:
0/2-Pyridinylmethylsulfinylbenzimidazoles; 0/Biological Markers; 0/Chelating Agents; 0/Phosphates; 0/Placebos; 0/Polyamines; 0/Proton Pump Inhibitors; 182683-00-7/sevelamer; D8TST4O562/pantoprazole

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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