Renal Failure Clinical Trial
Official title:
Parathyroid Hormone Levels in Relation to the Phosphorus Content of Meals
Patients on hemodialysis tend to have chronic elevations in the level of phosphorus in the blood and a secondary increase in the iPTH level. This chronic elevation in iPTH can have adverse consequences, thus a variety of phosphate binders are given in an attempt to decrease the absorption of phosphorus present in the normal diet. Some preliminary studies have indicated that the iPTH level may change based on the amount of phosphorus present in a meal prior to any significant absorption of phosphorus. If this is true in hemodialysis patients, then the timing of the administration of phosphate binders in relation to the ingestion of meals needs to be considered
Drugs used will include three phosphate binders already approved and commonly used. Calcium
acetate, aluminum hydroxide, and sevelamer (Renagel) will be given on separate occasions in
conjunction with a high phosphorus meal. They will be given in standard doses used in the
treatment of high phosphorus levels in hemodialysis patients.
The population targeted will included hemodialysis patients with elevated iPTH and
phosphorus levels.
The patients will receive up to five separate meals. Four of these will be high phosphorus
content meals and one will be a low phosphorus content meal. On up to three occasions with
the high phosphorus content meals the patients will ingest one of the three phosphate
binders. The meals will be ingested after a twelve-hour overnight fast. Labs will be drawn
prior to meal ingestion and then at 15, 30, 60, 120 and 240-minute intervals. The labs will
consist of iPTH, phosphorus, calcium, and glucose. A serum albumin level will be obtained
with the initial specimen only. The patients will have an iPTH level of at least 200pg/ml
and a serum phosphorus level of at least 4.0 mg/dl.
The primary outcome will be the change in the iPTH level in relation to the phosphorus
content of the meals. Secondary outcomes will include the change in iPTH level in relation
to the various phosphate binders being used.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Primary Purpose: Prevention
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