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Randomized Controlled Trial
. 2020 Apr 1;35(4):616-623.
doi: 10.1093/ndt/gfaa010.

Differential effects of phosphate binders on vitamin D metabolism in chronic kidney disease

Charles Ginsberg  1   2 , Leila R Zelnick  3 , Geoffrey A Block  4 , Glenn M Chertow  5 , Michel Chonchol  6 , Andrew Hoofnagle  7 , Bryan Kestenbaum  3 , Ian H de Boer  3   8
Affiliations
Randomized Controlled Trial

Differential effects of phosphate binders on vitamin D metabolism in chronic kidney disease

Charles Ginsberg et al. Nephrol Dial Transplant. .

Abstract

Background: Phosphate binders are commonly used in the treatment of patients with hyperphosphatemia. While phosphate binders are used to lower phosphate, the effects of specific phosphate binder types on vitamin D metabolism are unknown.

Methods: We performed a secondary analysis of the Phosphate Normalization Trial in which patients with moderate to advanced chronic kidney disease were randomized to receive either placebo, sevelamer carbonate, lanthanum carbonate or calcium acetate for 9 months. We evaluated changes in serum concentrations of vitamin D metabolites including 24,25-dihydroxyvitamin D3 [24,25(OH)2D3], 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], the ratio of 24,25(OH)2D3 to 25-hydroxyvitamin D [the vitamin D metabolite ratio (VMR)] and the ratio of serum 1,25(OH)2D to 25-hydroxyvitamin D.

Results: Compared with placebo, randomization to the calcium acetate arm was associated with a 0.6 ng/mL (95% CI 0.2, 1) and 13.5 pg/ng (95% CI 5.5, 21.5) increase in 24,25(OH)2D and VMR, respectively, and a 5.2 pg/mL (95% CI 1.1, 9.4) reduction in 1,25(OH)2D. Randomization to sevelamer carbonate was associated with a 0.5 ng/mL (95% CI -0.9, -0.1) and 11.8 pg/ng (95% CI -20, -3.5) reduction in 24,25(OH)2D3 and VMR, respectively. There was no association of the sevelamer arm with the change in 1,25(OH)2D3, and randomization to lanthanum carbonate was not associated with a change in any of the vitamin D metabolites.

Conclusion: Administration of different phosphate binders to patients with moderate to severe CKD results in unique changes in vitamin D metabolism.

Keywords: CKD-MBD; chronic renal insufficiency; mineral metabolism; phosphate binders; vitamin D.

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Figures

Graphical Abstract
Graphical Abstract
FIGURE 1
FIGURE 1
Regulation of vitamin D metabolism.
FIGURE 2
FIGURE 2
Cohort diagram for PNT.
FIGURE 3
FIGURE 3
Change in FGF-23, PTH and vitamin D metabolite ratios in PNT, by group and time.
See this image and copyright information in PMC

References

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    1. Block GA, Wheeler DC, Persky MS. et al. Effects of phosphate binders in moderate CKD. J Am Soc Nephrol 2012; 23: 1407–1415 - PMC - PubMed
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    1. Bosworth C, de Boer IH.. Impaired vitamin D metabolism in CKD. Semin Nephrol 2013; 33: 158–168 - PMC - PubMed
    1. Levin A, Bakris GL, Molitch M. et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007; 71: 31–38 - PubMed

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