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Article Review/Hyperlink
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Spengler K, Follmann H, Boos K-S, Seidel D, et al
Cross-linked iron dextran is an efficient oral phosphate
binder in the rat
Nephrol Dial Transplant
(May) 11:808-812 1996

The authors investigated the phosphorus binding properties of iron (III)
oxide-hydroxide modified
dextran beads in vitro and in normal rats. The maximum binding in an aqueous
solution was at pH 2-3
and was temperature dependent. Twelve animals had the binder added to their
food in the proportion
of 8% by weight. After 2 and 4 weeks the P and Ca levels were not different
than controls.
However, the renal excretion of P was 15 fold lower in the treated group.
The amount of P in the
stool was 3 times greater in the treated group. The treated group digested
15% less food than the
controls. Histological examination of virtually all organs revealed no
abnormality. The authors'
calculated that 1 g of the binder would bind about 20 mg of P. They feel
that studies in humans are
warranted.
Comment: A non-toxic, potent P binder not containing Ca would be of
great value in the
treatment of secondary hyperparathyroidism in renal failure. The iron
dextran beads clearly bind P
in the intestine but it appears to be a rather weak binder. One would also
worry about the
decreased digestion of food with the binder and possible long-term
malnutrition. I would imagine
that studies in humans have already started. (Jay Delmez, M.D., Washington
University at St.
Louis, MO)
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