July 31, 2013
Increased Risk of Death for Chronic Kidney Disease Patients on Calcium Phosphate Binders

Toronto, ON—Calcium-based phosphate binders may be dangerous for patients with chronic kidney disease, increasing their risk of death from heart disease by 22% compared to those who use noncalcium–based therapies, a new study suggests.

The study, published in the Lancet, suggests that some of the calcium is absorbed into the blood stream and could expedite atherosclerosis, leading to a higher risk of heart disease and even death. Even without calcium supplementation, cardiovascular disease is a leading cause of death in chronic kidney disease.

“Doctors commonly prescribe calcium supplements to prevent elevated phosphate levels, which can damage the body, but a growing number of studies have shown calcium supplements may actually increase the risk of heart disease,” explained lead author Sophie Jamal, MD, PhD, a physician at Women’s College Hospital and an associate professor of medicine at the University of Toronto. “Our study validates these claims and, for the first time, shows the long-term consequences of taking calcium supplements can be dangerous for patients with kidney disease.”

For their analysis, researchers reviewed 11 randomized, controlled studies that included more than 4,600 patients. They assessed the risk of heart disease—including heart attack, stroke, and atherosclerosis—and deaths in patients prescribed phosphate binders with and without calcium.

The review found that patients taking the noncalcium–based phosphate binders sevelamer and lanthanum had a 22% reduction in death and less artery calcification than patients on calcium-based phosphate binders.

“Some researchers and physicians have been saying for years that kidney disease patients need to get off calcium, now we think our review shows there is much more solid evidence to argue for that change to clinical practice,” said the study’s senior author, Ross Tsuyuki, BSc(Pharm), PharmD, MSc, from the University of Alberta’s faculty of medicine and dentistry.

Based on the results, study authors recommend that noncalcium phosphate binders be used as a first line of treatment for patients with chronic kidney disease.

“The findings of our study provides the best evidence as to what doctors should be prescribing their patients, but further research is necessary to help us understand how exactly calcium increases the risk of death, if non calcium-based treatments reduce the risk of death, and whether certain types of treatments may be more effective and beneficial than others,” Jamal said.

U.S. Pharmacist Social Connect