Use of a new phosphate binder in chronic renal insufficiency

Use of a new phosphate binder in chronic renal insufficiency. The role of phosphorus retention in the development of secondary hyperparathyroidism in renal failure is well established. Unfortunately, there are no nutritionally complete, palatable, low-phosphorus diets. Thus, phosphorus-binding gels have been prescribed to control phosphorus absorption from the gastrointestinal tract. Most of these binders are aluminum-containing preparations designed to be used as antacids and, as such, were not optimized for high anion binding capacity. We have prepared a new phosphorus binder, an aluminum oxide-based gel, with an increased anion binding capacity. This material (Controphos TM ) was incorporated into breadsticks in order to increase patient tolerance. Toxicologic studies performed in rats indicated that the animals ingesting this experimental binder did not show increased aluminum concentration in the brain. Metabolic studies in which oxygen consumption was determined in cortical renal slices suggested that a decrease in oxygen consumption was due to phosphate deficiency and not to the binder itself. Studies in dialysis patients clearly demonstrated that hyperphosphatemia can be easily corrected. Moreover, balance studies in patients with chronic renal failure indicated that this experimental binder incorporated into breadsticks is as effective as the best available phosphorus binder (aluminum carbonate gel, Basaljel®). When aluminum carbonate gel, however, was incorporated into breadsticks, its capacity to bind phosphorus was greatly reduced. Summary. A new phosphorus binder that retains high binding capacity even when incorporated into breadsticks was well accepted and tolerated by patients with chronic renal failure. Emploi d'un nouveau chelateur du phosphore dans l'insuffisance renale chronique. Le role de la retention de phosphore dans le developpement de l'hyperparathyroidisme secondaire de l'insuffisance renale est bien etabli. Malheureusement il n'existe pas de regimes pauvres en phosphate complets du point de vue nutritionnel et de gout agreable. Par consequent les gels qui se combinent au phosphore ont ete prescrits pour en limiter l'absorption digestive. La plupart de ces substances contiennent d'aluminium, qui a une capacite de liaison aux anions accrue. Cette substance (Controphos TM ) a ete incorporee a des gressins pour en augmenter la tolerance. Les etudes toxicologiques realisees chez le rat indiquent que les animaux qui ingerent cette substance n'ont pas d'augmentation de la concentration cerebrale d'aluminium. Les etudes metaboliques dan lesquelles la consommation d'oxygene de tranches de cortex renal a ete determinee suggerent que la diminution de cette consommation est due au deficit du phosphate et non a la substance ellememe. Les etudes faites chez des malades en dialyse demontrent que l'hyperphosphatemie peut etre facilement corrigee. Les etudes de bilan chez des malades en insuffisance renale chronique indiquent que cette substance incorporee dans des gressins est aussi efficace que le meilleur produit jusque la disponible (gel de carbonate d'aluminium, Basaljel®). Cependant quand ce gel a ete incorpore dans des gressins, sa capacite a lier le phosphore a ete considerablement reduite. En resume, un nouveau chelateur du phosphore, qui conserve sa grande capacite quand il est incorpore a des gressins, a ete bien accepte et supporte par des malades en insuffisance renale chronique.