Comment on 'Magnesium and chronic kidney disease'
Comentario a «Magnesio y enfermedad renal crónica»
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In one particular series on 32 patients, phosphate binders were compared with calcium and metal binders.<span class="elsevierStyleSup">2</span> However, this line of work was lost with the development of new binders (sevelamer and lanthanum). We have recently carried out studies that have renewed interest in CAMG in haemodialysis (HD), comparing its efficacy with that of other monotherapy binders. Nevertheless, we do not have similar clinical trials for PD. Studies that achieved the authorisation of CAMG included PD patients, but no specific subanalyses have been carried out on patients using this home technique. We already reported the need to carry out this type of study, since hyperparathyroidism (HPTH) management in PD is not identical to that of HD.<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">As such, we wanted to contribute data on our preliminary experience with 10 patients on PD with moderate HPTH (mean baseline parathyroid hormone [PTH] 277pg/ml, range [150-606]), who we treated with CAMG (Osvaren<span class="elsevierStyleSup">®</span>) for 6 months. Our main objective was to assess the tolerability and safety of the drug and obtain preliminary results on its efficacy in the control of serum phosphorus. The patients (54.8±9.4 years and 50% male) had a median time of 6.3 months on PD (7 on continuous ambulatory peritoneal dialysis, 3 on automated peritoneal dialysis) and achieved the dialysis efficacy objectives. The median treatment dose during follow-up was 2 pills per day (range 1-3). Treatment was well tolerated in all cases and it was not necessary to reduce the dose due to side effects. In two patients it was necessary to re-introduce another phosphorus binder at low doses (in one 750mg/24h of lanthanum carbonate and in another 1200mg/24h of sevelamer carbonate); 7 received Zemplar<span class="elsevierStyleSup">®</span> and 3 Mimpara<span class="elsevierStyleSup">® </span>from 3 months before the start of CAMG. At the start of treatment 7 patients displayed phosphorus within the range specified by the K/DOQI guidelines with the foregoing regimen and in just 4 months, all patients were well-controlled with CAMG. The number of patients who simultaneously achieved the objectives for phosphorus and PTH set by the K/DOQI guidelines increased from 4 to 8 in this time. Mean phosphorus had decreased from 4.8±0.6mg/dl to 4.6±1.0mg/dl at the end of the six-month follow-up.</p><p class="elsevierStylePara">We are aware of the limitations of our preliminary analysis, but we are interested in demonstrating the possibility of using CAMG in PD. It is striking that in the 30 laboratory tests we carried out during follow-up, we only found one high magnesium value (1.8mmol/l) and none for calcium above 10.5mg/dl. There was no clinical impact in any of these cases and it was easily corrected by adjusting the dialysate or diet. Four patients had cramp at the start and none at the end of follow-up. None of the patients displayed gastrointestinal intolerance and treatment allowed for a reduced use of laxatives.</p><p class="elsevierStylePara">The small amount of data available on the use of CAMG in PD may be due, on the one hand, to the fear of side effects (gastrointestinal intolerance and hypermagnesaemia), and on the other, to the difficulty of carrying out studies in PD units, which are still small in our country.</p><p class="elsevierStylePara">We have indirect evidence that hypomagnesaemia causes greater clinical problems than hypermagnesaemia in PD patients,<span class="elsevierStyleSup">4 </span>similarly to that reported by De Francisco for HD patients.<span class="elsevierStyleSup">1</span> In fact, several observational studies have found that low magnesium is associated with worse control of HPTH, more calcifications, malnutrition and higher mortality.<span class="elsevierStyleSup">5,6</span></p><p class="elsevierStylePara">Furthermore, the laxative effect is interesting in PD, since the vast majority of patients require laxative drugs to achieve an adequate bowel pattern (one stool deposition per day). In conclusion, the cost of new non-calcium binders is 6 times the cost of CAMG, which is relevant for the sustainability of our health care system.<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">Due to all of the above, we believe that CAMG may have a role to play as the first line of treatment in PD and that more PD-specific studies are necessary.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article.</p>" "pdfFichero" => "P1-E562-S4416-A12156-EN.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439592" "palabras" => array:1 [ 0 => "Phosphorus binders" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439594" "palabras" => array:1 [ 0 => "Calcium/Magnesium carbonate" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439596" "palabras" => array:1 [ 0 => "PPeritoneal dialysis" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "De Francisco ALM, Rodríguez M. Magnesio y enfermedad renal crónica. Nefrologia 2013;33(3):389-99. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23640095" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Parsons V, Baldwin D, Moniz C, Mardsen J, Ball E, Rifkin I. Successful control of HPTH in patients in CAPD using magnesium carbonate and calcium carbonate as phosphate binders. Nephron 1993;63:379-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8459870" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Portolés J, López-Sánchez P, Bajo MA, Castellano I, del Peso G, Rodríguez JR, et al. Cinacalcet improves control of secondary hyperparathyroidism in peritoneal dialysis: a multicenter study. Perit Dial Int 2012;32(2):208-11. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22383721" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tzanakis IP, Oreopoulos DG. Beneficial effects of magnesium in chronic renal failure: a foe no longer. Int Urol Nephrol 2009;41:363-71. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19115076" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wei M, Esbaei K, Bargman J, Oreopoulos DG. Relationship between serum magnesium, parathyroid hormone, and vascular calcification in patients on dialysis: a literature review. Perit Dial Int 2006;26:366-73. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16722031" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fein P, Suda V, Borawsky C, Kapupara H, Butikis A, Matza B, et al. Relationship of serum magnesium to body composition and inflammation in peritoneal dialysis patients. Adv Perit Dial 2010;26:112-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21348392" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "De Francisco AL. 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| 2020 March | 15 | 9 | 24 |
| 2020 February | 28 | 20 | 48 |
| 2020 January | 37 | 14 | 51 |
| 2019 December | 23 | 21 | 44 |
| 2019 November | 17 | 17 | 34 |
| 2019 October | 6 | 6 | 12 |
| 2019 September | 15 | 17 | 32 |
| 2019 August | 8 | 10 | 18 |
| 2019 July | 16 | 23 | 39 |
| 2019 June | 25 | 11 | 36 |
| 2019 May | 13 | 16 | 29 |
| 2019 April | 35 | 34 | 69 |
| 2019 March | 16 | 15 | 31 |
| 2019 February | 18 | 13 | 31 |
| 2019 January | 25 | 23 | 48 |
| 2018 December | 71 | 37 | 108 |
| 2018 November | 84 | 18 | 102 |
| 2018 October | 72 | 19 | 91 |
| 2018 September | 50 | 15 | 65 |
| 2018 August | 37 | 24 | 61 |
| 2018 July | 46 | 17 | 63 |
| 2018 June | 35 | 14 | 49 |
| 2018 May | 35 | 12 | 47 |
| 2018 April | 31 | 8 | 39 |
| 2018 March | 32 | 12 | 44 |
| 2018 February | 32 | 12 | 44 |
| 2018 January | 35 | 7 | 42 |
| 2017 December | 32 | 8 | 40 |
| 2017 November | 37 | 11 | 48 |
| 2017 October | 31 | 8 | 39 |
| 2017 September | 45 | 12 | 57 |
| 2017 August | 41 | 13 | 54 |
| 2017 July | 39 | 14 | 53 |
| 2017 June | 41 | 10 | 51 |
| 2017 May | 36 | 17 | 53 |
| 2017 April | 40 | 9 | 49 |
| 2017 March | 32 | 5 | 37 |
| 2017 February | 27 | 13 | 40 |
| 2017 January | 16 | 9 | 25 |
| 2016 December | 48 | 9 | 57 |
| 2016 November | 65 | 7 | 72 |
| 2016 October | 69 | 16 | 85 |
| 2016 September | 101 | 3 | 104 |
| 2016 August | 154 | 5 | 159 |
| 2016 July | 208 | 11 | 219 |
| 2016 June | 124 | 0 | 124 |
| 2016 May | 141 | 0 | 141 |
| 2016 April | 121 | 0 | 121 |
| 2016 March | 107 | 0 | 107 |
| 2016 February | 99 | 0 | 99 |
| 2016 January | 131 | 0 | 131 |
| 2015 December | 129 | 0 | 129 |
| 2015 November | 95 | 0 | 95 |
| 2015 October | 89 | 0 | 89 |
| 2015 September | 76 | 0 | 76 |
| 2015 August | 79 | 0 | 79 |
| 2015 July | 66 | 0 | 66 |
| 2015 June | 61 | 0 | 61 |
| 2015 May | 46 | 0 | 46 |
| 2015 April | 7 | 0 | 7 |
Show all
