Proton Pump Inhibitors May Improve Phosphate Control

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ORLANDO, Fla.—Proton pump inhibitors (PPIs) taken concurrently with phosphate binders may increase phosphate control in hemodialysis (HD) patients, according to researchers.

A team based at New York Hospital Queens, Flushing, N.Y., studied 108 HD patients on stable dosages of phosphate binders over a three-month period. They looked at the relationship between PPIs and two types of phosphate binders (calcium acetate and sevelamer hydrochloride). Of the 108 patients, 37 were taking PPIs. Of the 37, 19 were on calcium acetate and 18 were on sevelamer hydrochloride.

Ebima Okundaye, MD, and colleagues explained that PPIs can alter the acid level of the stomach, thus affecting the metabolism and effects of phosphate binders.

The investigators followed phosphate levels monthly for three months. They considered patients controlled if the average phosphorus level was below 6 mg/dL and the calcium × phosphate product was less than 55 mg/dL.

A significantly higher number of patients taking both phosphate binders and PPIs achieved phosphate control compared with patients taking phosphate binders alone, the investigators reported here at the National Kidney Foundation's 2010 Spring Clinical Meetings. This association, however, was significant only among patients taking sevelamer, with 16 (88%) of 18 patients taking sevelamer plus a PPI achieving control compared with 28 (61%) of 46 patients taking sevelamer and no PPI.

The researchers concluded that concomitant use of PPIs and phosphate binders does not reduce the efficacy of phosphate control in HD patients.
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