Document Detail

Effect of gastric acid suppression with pantoprazole on the efficacy of calcium carbonate as a phosphate binder in haemodialysis patients.
MedLine Citation:
PMID:  22471559     Owner:  NLM     Status:  MEDLINE    
AIM:   Metallic phosphate binders require acidity to dissociate to the free metallic ion and bind phosphorus. Altered gastric acidity may, therefore, influence phosphate-binding efficacy. We evaluated the clinical effect of pantoprazole on the efficacy of calcium carbonate phosphate binders in haemodialysis patients.
METHODS:   The study had two parts: a cross-sectional study (n = 67), and an interventional, crossover, double-blind, randomized, placebo-controlled trial in 26 patients given pantoprazole 40 mg daily or placebo for two consecutive 6-week periods.
RESULTS:   The cross-sectional study showed no difference between those on and off acid suppressants in phosphate (1.43 ± 0.45 vs 1.46 ± 0.31 mmol/L, P = 0.782) or other parameters except age (72.2 ± 9.8 vs 63.8 ± 14.8 years, P = 0.01). In the interventional study, phosphate was higher during pantoprazole than placebo (1.59 ± 0.3 vs 1.42 ± 0.3 mmol/L, P = 0.005). Serum calcium (2.37 ± 0.2 vs 2.46 ± 0.2 mmol/L, P = 0.012) and ionized calcium (1.17 ± 0.1 vs 1.22 ± 0.1 mmol/L, P = 0.013) were lower during pantoprazole treatment. CaxPO(4) (3.76 ± 0.7 vs 3.48 ± 0.7 mmol(2) /L(2) , P = 0.032) and intact parathyroid hormone (31.9 ± 21.4 vs 23.6 ± 17.7 pmol/L, P = 0.004) were higher on pantoprazole.
CONCLUSION:   These results demonstrate clinical evidence for an adverse effect of gastric acid suppression on the effectiveness of calcium carbonate phosphate binders. Given their frequent co-prescription, this interaction may be a minor but common reason why some patients fail to control hyperphosphataemia. Clinicians should regularly assess the need for acid suppressants. Further studies are needed to investigate interactions with other phosphate binders.
Matthew J Cervelli; Ahmed Shaman; Anthony Meade; Robert Carroll; Stephen P McDonald
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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 Jul 
Date Detail:
Created Date:  2012-06-25     Completed Date:  2012-10-29     Revised Date:  2013-06-04    
Medline Journal Info:
Nlm Unique ID:  9615568     Medline TA:  Nephrology (Carlton)     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  458-65     Citation Subset:  IM    
Copyright Information:
© 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.
Department of Pharmacy, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
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MeSH Terms
2-Pyridinylmethylsulfinylbenzimidazoles / adverse effects,  therapeutic use*
Aged, 80 and over
Biological Markers / blood
Calcium / blood
Calcium Carbonate / adverse effects,  therapeutic use*
Chelating Agents / adverse effects,  therapeutic use*
Cross-Over Studies
Cross-Sectional Studies
Double-Blind Method
Drug Interactions
Gastric Acid / secretion*
Gastric Mucosa / drug effects*,  secretion
Hydrogen-Ion Concentration
Hyperphosphatemia / blood,  drug therapy*,  etiology
Kidney Failure, Chronic / blood,  complications,  therapy*
Middle Aged
Parathyroid Hormone / blood
Phosphates / blood*
Proton Pump Inhibitors / adverse effects,  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/PTH protein, human; 0/Parathyroid Hormone; 0/Phosphates; 0/Proton Pump Inhibitors; 471-34-1/Calcium Carbonate; 7440-70-2/Calcium; D8TST4O562/pantoprazole

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