Effects And Safety Of Salmon Calcitonin On Calcium And Phosphorus Metabolism Disorder In Hemodialysis Patients With Hypercalcemia

Phosphorus is a critical element in humerous physiologic functions such as cell membrane phospholipid function,mineral metabolism,skeletal development.In normal human body,the serum phosphate concentration is mainly determined by the ability of the kidney to excrete dietary phosphate.The balance can be maintained by the renal excretion very well.In ESRD patiens,the reduction in glomerular filtration rate(GFR) will diminish phosphate filtration and excretion.when the GFR falls below 20-25ml/min,urinary excretion is not able to counterbalance dietary phosphate intake,the balance is broken.Hyperphosphatemia is evident as renal failure progresses,it is a common complication in patients with ESRD and it is affecting up to 70% of dialysis patients.The clinical consequences of Hyperphosphatemia are include cardiovascular calcification,secondary hyperparathyroidism and renal osteodystrophy.Hyperphosphatemia have been correlated with high rate of cardiovascular disease and mortality in patients receiving dialysis.Therefore,more rigorous control of serum phosphorus is critically important in patients with dialysis. Despite dietary advice to restrict phosphate intake, and as a result of conventional dialysis therapy, the reduced ability of the kidneys to excrete serum phosphate (SP) leads to hyperphosphatemia in most patients.So additional treatment with a phosphate binder is required to control serum phosphate levels within the target range.In China, first-line treatment of hyperphosphatemia consists primarily of calcium carbonate (CC). Because it reduces the serum phosphate level effectively in addition to correcting hypocalcemia. However, large or improperly administered calcium intake may lead to hypercalcemia, and may be associated with an increased risk of vascular calcification and can also limit the use of vitamin D analogs due to hypercalcemia. Hypercalcemia affects almost all organ in the body especially the central nervous system,cardiovascular system,bone and kidney.Severe hypercalcemia is a life-threatening emergency.So we must find the right treatment to low serum calcium. Sevelamer hydrochloride, a metal-free, calcium-free hydrogel, is not absorbed, has been proven safe and efficacious in controlling serum phosphorus, and is associated with attenuated progression of cardiovascular calcification. Lanthanum carbonate is a newer aluminum-free, calcium-free phosphate-binding agent.Lanthanum is a rare-earth trace metal with industrial and agricultural applications.But the price of them is too expensive for patients with hemodialysis to afford treatment costs. So we must find new therapeutic method to solve this problem.Calcitonin (CT) is a 32-amino acid peptide belonging to a small family of peptides and it was discovered as an acute hypocalcaemic hormone released from the parathyroid glands.Calcitonin could inhibit bone resorption in vitro and vivo and prevent calcium efflux from bone. At present,calcitonin is widely used to treat osteoporosis,Paget’s disease and hypercalcemia conditions.. There are few published studies available for patients on Hemodialysis about efficacy of calcitonin on lowering serum calcium. Therefore, The prospective trial was therefore designed to observe efficacy and safety of calcition in the treatment of Hypercalcemia and hyperphosphatemia in maintenance hemodialysis patients.PART ⅠEffect of salmon calcitonin on hypercalcemia in hemodialysis patientsObjectiveThis short-term study assessed the efficacy and safety of salmon calcition in the treatment of Hypercalcemia in hemodialysis patients.MethodsPatients (n=64) with hemodialysis for chronic kidney disease for more than 6 months were included based on total SCa more than 10.5 mg/dL. Patients were randomly(computer generated) assigned into group Ⅰ and group Ⅱ in a 1:1 ratio.32 patients (group Ⅰ) received subcutaneous injection of salmon calcition. (50 U) three times a week for 1 month,32 patients (group Ⅱ) received subcutaneous injection of salmon calcition.(100 U) three times a week for 1 months.Blood levels of Ca, Pwere measured every one week, iPTH was measured at 4 weeks.ResultsDuring the study period, Serum calcium decreased from 10.72±0.39 to 9.25±0.28mg/dL in group Ⅰ (P<0.05),serum calcium decreased from 10.79±0.41 to 9.02±0.24mg/dL in group Ⅱ (P<0.05).Serum phosphorus increased from 5.79±1.05 to 6.46±1.18mg/dL (P<0.05) in group Ⅰ, serum phosphorus increased from 5.64±1.05 to 6.43±1.28mg/dL (P<0.05) in group Ⅱ.At 4 weeks,iPTH in the group Ⅰ and group Ⅱ were increaesd significantly when compared with those at baseline (P<0.05)ConclusionsSalmon calcitonin can effectively and safely control hypercalcinemia and decrease the incidence of hypercalcinemia in maintenance dialysis patients.There were no serious treatment-related adverse events in treatment with salmon calcitonin.PART ⅡEffect of salmon calcitonin on calcium and phosphorus metabolism disorder in hemodialysis patients with hypercalcemiaObjectiveThis short-term study assessed the efficacy and safety of salmon calcition in the treatment of calcium and phosphorus metabolism disorder in hemodialysis patients with hypercalcemia.MethodsPatients (n=60) with hemodialysis for chronic kidney disease for more than 6 months were included based on total SCa more than 10.5 mg/dL. Patients were randomly(computer generated) assigned into group Ⅰ and group Ⅱ in a 1:1 ratio.30 patients (group Ⅰ) received calcium carbonate combined with calcitonin for 12 weeks, 30 patients (group Ⅱ) received lanthanum carbonate (Group Ⅱ) for 12 weeks. Blood levels of calcium, phosphorus and intact parathyroid hormone (iPTH) were measured every month, bone mass density (BMD) and coronary artery calcium scores (CACS) were measured at baseline and 3 months.ResultsDuring the study period,serum calcium decreased from 10.72±0.39 to 10.09 ±0.28 mg/dL (P<0.05), serum phosphorus decreased from 6.79±1.05 to 5.46 ±1.18 mg/dL (P<0.05), and serum iPTH levels in the Group Ⅰ and Group Ⅱ were not significantly different from the baseline.There were no significant differences in CACS in either group.There were no significant differences in the BMD values between Group Ⅰ and baseline. In Group Ⅱ, the BMD values at the lumbar spine and femoral neck were significantly lower than those before the trial and significantly lower than the corresponding values of Group Ⅰ (P<0.05).ConclusionsCalcium carbonate combined with calcitonin and lanthanum carbonate were equally effective in the therapy of calcium and phosphorus metabolism disorder in hemodialysis patients with hypercalcemia.There were no serious treatment related adverse events in treatment with calcium carbonate combined with calcitonin.