The Use of Magnesium-Containing Phosphate Binders in Patients with End-Stage Renal Disease on Maintenance Hemodialysis

Guillot, Ann; Hood, Virginia L.; Runge, Carl; Gennari, F. John

doi:10.1159/000182446

Cited by 82 publications

(29 citation statements)

References 11 publications

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“…Hypermagnesemia is common in patients on hemodialysis (19) and sustained hypermagnesemia in a high proportion of peritoneal dialysis patients has also been described (20). Hypermagnesemia at levels up to 1.5 mmol/L is only rarely associated with clinical effects that are usually mild in severity (21)(22)(23)(24)(25)(26). Neuromuscular toxicity, although not evident in this study, may become apparent at levels of 2 to 3 mmol/L (27).…”

Section: Discussionmentioning

confidence: 61%

Iron-Magnesium Hydroxycarbonate (Fermagate)

McIntyre

Pai

Warwick

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: This phase II study tested the safety and efficacy of fermagate, a calcium-free iron and magnesium hydroxycarbonate binder, for treating hyperphosphatemia in hemodialysis patients.Design, setting, participants, & measurements: A randomized, double-blind, three-arm, parallel-group study compared two doses of fermagate (1 g three times daily or 2 g three times daily with placebo). Sixty-three patients who had been on a stable hemodialysis regimen for >3 mo were randomized to the treatment phase. Study medication was administered three times daily just before meals for 21 d. The primary endpoint was reduction in serum phosphate over this period.Results: In the intention-to-treat analysis, mean baseline serum phosphate was 2.16 mmol/L. The fermagate 1-and 2-g three-times-daily treatment arms were associated with statistical reductions in mean serum phosphate to 1.71 and 1.47 mmol/L, respectively. Adverse event (AE) incidence in the 1-g fermagate arm was statistically comparable to the placebo group. The 2-g arm was associated with a statistically higher number of patients reporting AEs than the 1-g arm, particularly gastrointestinal AEs, as well as a higher number of discontinuations, complicating interpretation of this dose's efficacy. Both doses were associated with elevations of prehemodialysis serum magnesium levels.Conclusions: The efficacy and tolerability of fermagate were dose dependent. Fermagate showed promising efficacy in the treatment of hyperphosphatemia in chronic hemodialysis patients as compared with placebo in this initial phase II study. The optimal balance between efficacy and tolerability needs to be determined from future dose-titration studies, or fixed-dose comparisons of more doses.

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Section: Discussionmentioning

confidence: 61%

Iron-Magnesium Hydroxycarbonate (Fermagate)

McIntyre

Pai

Warwick

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…Magnesium hydroxide use was complicated by diarrhea and mild hyperkalemia [11]. Magnesium carbonate (MgCO 3 ) proved more effective and resulted in fewer side effects.…”

Section: Magnesium As a Phosphate Bindermentioning

confidence: 99%

Magnesium in Chronic Kidney Disease: Unanswered Questions

Spiegel

2011

Blood Purif

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Background: Magnesium ion is critical for life and is integrally involved in cellular function and a key component of normal bone mineral. In health, the kidneys, gastrointestinal tract and bone are responsible for maintaining serum magnesium concentrations in the normal range and magnesium balance. Most clinical disorders involving magnesium, other than chronic kidney disease (CKD), result in hypomagnesemia, either from gastrointestinal or kidney losses. CKD and particularly end-stage kidney disease is the only clinical condition where sustained hypermagnesemia may occur and net magnesium balance may be positive. Methods: This review will focus on normal magnesium homeostasis and review the literature in CKD with a particular focus on end-stage kidney disease and the potential role of magnesium as a phosphate binder and in cardiovascular and bone health. Results: A number of small to medium-size interventional trials have shown that magnesium-based compounds can serve as effective phosphate binders. Observational studies suggest that higher serum magnesium concentrations in dialysis patients may improve survival and may slow the progression of vascular calcification. While a few small prospective trials support these findings, no large or long-term studies are available. Conclusions: Magnesium balance remains poorly understood in patients with end-stage kidney disease. While observational and small randomized trials suggest that exogenous administration may be useful as a phosphate binder and may have protective cardiovascular effects in terms of both arrhythmias and vascular calcification, large randomized trials are needed to test these hypotheses.

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“…However, these agents are not particularly effective as phosphate binders, and adjustments in dialysate magnesium are necessary (42). Given the lower efficacy of phosphorus binding of magnesium salts, larger doses are required and adverse GI effects such as diarrhea, hyperkalemia, and hypermagnesemia are often treatment limiting (43)(44)(45).…”

Section: Magnesium Saltsmentioning

confidence: 99%

Control of Hyperphosphatemia among Patients with ESRD

Coladonato¹

2005

Journal of the American Society of Nephrology

102

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Derangements of mineral metabolism occur during the early stages of chronic kidney disease (CKD). Hyperphosphatemia develops in the majority of patients with ESRD and has long been associated with progression of secondary hyperparathyroidism and renal osteodystrophy. More recent observational data have associated hyperphosphatemia with increased cardiovascular mortality among dialysis patients. Adequate control of serum phosphorus remains a cornerstone in the clinical management of patients with CKD not only to attenuate the progression of secondary hyperparathyroidism but also possibly to reduce the risk for vascular calcification and cardiovascular mortality. These measures include dietary phosphorus restriction, dialysis, and oral phosphate binders. Dietary restriction is limited in advanced stages of CKD. Phosphate binders are necessary to limit dietary absorption of phosphorus. Aluminum hydroxide is an efficient binder; however, its use has been nearly eliminated because of concerns of toxicity. Calcium salts are inexpensive and have been used effectively worldwide as an alternative to aluminum. Concerns of calcium overload have led to the investigation of alternatives. Currently, only two Food and Drug Administration-approved noncalcium, nonaluminum binders are available. Sevelamer hydrochloride is an exchange resin and was not as effective as calcium acetate in meeting new guideline recommendations in one double-blind clinical trial. Lanthanum carbonate is a rare earth element and has been studied less extensively. Concerns of long-term administration and toxicity exist. Furthermore, these agents are significantly more expensive than calcium salts, which may contribute to patient noncompliance.

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The Use of Magnesium-Containing Phosphate Binders in Patients with End-Stage Renal Disease on Maintenance Hemodialysis

Cited by 82 publications

References 11 publications

Iron-Magnesium Hydroxycarbonate (Fermagate)

Iron-Magnesium Hydroxycarbonate (Fermagate)

Magnesium in Chronic Kidney Disease: Unanswered Questions

Control of Hyperphosphatemia among Patients with ESRD

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