Burke SK, Dillon MA, Slatopolsky EA, Goldberg DI
Renagel lowers serum phosphorus and intact
parathyroid hormone in hemodialysis patients
NKF 6th Spring Clinical Meeting (Dallas)
Am J Kidney Dis
(Apr) 29:A5 1997
Renalgel is a non-absorbed phosphate binding polymer free of calcium
and aluminum undergoing testing to attain FDA approval. 172
hemodialysis patients were studied. They stopped taking their usual
phosphorus binders for two weeks and were elibible for study if the
phosphorus level increased to >6 mg/dl. They then took 6-12
caps/day of Renalgel depending on the phosphorus level. The dose was
titrated to control phosphorus levels over an 8 week period.
The phosphorus levels decreased from around 9 to 6 mg/dl with
treatment. PTH levels decreased from 450 to 350 pg/ml. Calcium
levels remained around 9 mg/dl. The change in PTH levels correlated
with the change in phosphorus levels. Renalgel was well tolerated.
The authors conclude that Renalgel is an effective phosphorus binder.
They also felt that the data supported a direct effect of phosphorus
in the regulation of PTH in hemodialysis patients.
Comment: A simple but convincing study. Still to be answered
is the potential long term toxicity of the polymer. There is no
mention of the number of capsules required to control phosphorus, but
it appears that the phosphorus binding properties of the drug are not
robust. Nonetheless, Renalgel would be a welcome addition to the
current narrow choices of phosphorus binders. It could be
particularly useful in patients receiving calcitriol. (James A.
Delmez M.D., Washington University, St. Louis)
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NKF 6th Spring Clinical Meeting (Dallas)
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