Thursday, October 28, 2010


Calcium acetate/magnesium carbonate (CaMg) is a combination phosphate binder. 
Both can be used separately as binders.
What about using a combined Ca acetate with mg Carbonate binder?
Why ?
1. Less risk of hypercalcemia
2. Increased mg levels have been associated with benefits with vascular calcification and so forth.
A recent paper- nice prospective trial compared using a combination Ca and Mg product vs sevalemer HCL.
The study aim was to show non-inferiority of CaMg in lowering serum phosphorus levels into Kidney Disease Outcome Quality Initiative (K/DOQI) target level range after 24 weeks. Three hundred and twenty-six patients from five European countries were included. After a phosphate binder washout period, 255 patients were randomized in a 1:1 fashion. 204 patients finished the study. 
What did they find?
1. Serum phosphorus levels had decreased significantly with both drugs 25 weeks with equal effects in both arms.
2. Ionized serum calcium did not differ between groups.
3. An asymptomatic increase in serum magnesium occurred in CaMg-treated patients
4. There was no difference in the number of patients with adverse events.

1. No cardiovascular risk benefit analysis, not followed long term
2. It seems ca didn't differ, so then why use CaMg combination?
3. Serum magnesium levels are largely dependent on dialysis fluid concentration as the only possibility to eliminate magnesium is via dialysis once residual renal function has disappeared Does that mean we have to monitor for hypermagnesemia more often in this case, the risk is there. 
4. What about the effects of Mg on bone disease? I think there is data that it might be beneficial in lowering pth?But worth a read as it might be important to see long term effects.

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