Journal Article

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

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

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 11, issue 1, pages 70-74
Published in print January 1996 | ISSN: 0931-0509
e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/oxfordjournals.ndt.a027069
Effect of calcium-channel blockers on calcium—phosphate metabolism in patients with end-stage renal disease

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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.

Keywords: calcitriol; diltiazem; felodipine; haemodialysis; parathyroid hormone

Journal Article.  0 words. 

Subjects: Nephrology

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