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Effect of calcium-channel blockers on calcium—phosphate metabolism in patients with end-stage renal disease

Lippuner, K. ; Zehnder, H.-J ; Casez, J. P. ; Takkinen, R. ; Descoeudres, C. ; Jaeger, Ph

In: Nephrology Dialysis Transplantation, 1996, vol. 11, no. 1, p. 70-74

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    Titel
    • Effect of calcium-channel blockers on calcium—phosphate metabolism in patients with end-stage renal disease
    Autor
    • Lippuner, K.. Policlinic of Medicine, University Hospital, Berne, Switzerland
    • Zehnder, H.-J. Policlinic of Medicine, University Hospital, Berne, Switzerland
    • Casez, J. P.. Policlinic of Medicine, University Hospital, Berne, Switzerland
    • Takkinen, R.. Policlinic of Medicine, University Hospital, Berne, Switzerland
    • Descoeudres, C.. Policlinic of Medicine, University Hospital, Berne, Switzerland
    • Jaeger, Ph. Policlinic of Medicine, University Hospital, Berne, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Nephrology Dialysis Transplantation, 1996, vol. 11, no. 1, p. 70-74. Oxford University Press
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:301938
    Summary
    Background After EDTA-induced hypocalcaemia, healthy volunteers treated with diltiazem display more severe hyperparathyroidism than subjects on felodipine studied under identical conditions. Therefore patients with end-stage renal disease (ESRD) and severe secondary hyperparathyroidism might be particularly sensitive to this side-effect. Methods To test this hypothesis, seven patients with ESRD on chronic haemodialysis (3 women and 4 men) with serum levels of intact PTH ranging from 204 to 675 pg/ml were studied both before and during the first 180 min of haemodialysis against a dialysate with low calcium concentration (0.75 mmol/1, n=6 and 1 mmol/1, n=1) under the following three experimental conditions: control, felodipine (10 mg/day) and diltiazem (120 mg b.i.d.). Results At onset of dialysis, plasma phosphorus level was higher on diltiazem (2.03±0.08 mM) than on felodipine (1.64±0.10, P<0.02), and on the latter it was lower than in control condition (1.88±0.16, P<0.02). As a probable consequence, blood ionized calcium concentration was lower on diltiazem (1.14 mM±0.02, mean±SEM) than on felodipine (1.2±0.03, P<0.05) or in control condition (1.17±0.01, NS). There was a trend for intact PTH to be higher on diltiazem (324±47 pg/ml) than on felodipine (246±55) or in control condition (305±49) and 1,25-dihydroxyvitamin D was higher indeed on diltiazem (6.70±0.92 pg/ml) than on felodipine (4.75±0.91, P<0.02) or control (3.87±0.62, P<0.05). Area under the curve PTH over the first 60 min of dialysis was higher by 16±7% on diltiazem than on felodipine (P<0.05). Conclusions While on diltiazem rather than on felodipine, patients with ESRD display higher plasma phosphorus levels, and slightly aggravate the degree of severity of hyperparathyroidism recorded during haemodialysis against low-calcium dialysate. The longterm effect of this new observation remains to be evaluated