What is it about?
High serum oxalate levels are a new risk factor for sudden cardiac death in patients receiving hemodialysis. Calcium-based phosphate binders may also be advantageous binders for oxalate to decrease cardiac sudden death in those patients. Future research is hoped to elucidate it.
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Why is it important?
Calcium-based phosphate binders have been thought to contribute to cardiovascular deaths in patients receiving dialysis because they load calcium and promote calcification of coronary artery. However, they may be advantageous binders for oxalate. They may decrease high levels of serum oxalate to reduce cardiac sudden death in those patients contrary to conventional theory, because high serum oxalate levels are a new risk factor for sudden cardiac death in patients receiving dialysis.
Perspectives
Currently, the use of non-calcium-based phosphate binders in patients receiving dialysis tends to be recommended to prevent cardiovascular death, but evidence of their effectiveness in reducing this risk is lacking. These agents are associated with incidence of gastrointestinal complications, such as nausea and constipation, especially in Japan. We have often experienced in clinical practice that these side effects have impaired quality of life and nutritional status of patients. If calcium based phosphate binders are beneficial in preventing sudden cardiac death, use of calcium agents would decrease these side effects in patients.
Yoshinari Oka
Saiwaicho Memorial Hospital
Read the Original
This page is a summary of: Calcium-Based Phosphate Binders and Plasma Oxalate Concentration in Dialysis Patients, Journal of the American Society of Nephrology, May 2022, American Society of Nephrology,
DOI: 10.1681/asn.2022030248.
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