Title:
Effects of GI medication to the mineral metabolism contorl in patients undergoing hemodialysis.

Naoki Kimata¹ ;Naoki Kimata² ;Naoki Kimata³ ;Naoki Kimata³ ;Naoki Kimata¹

Tokyo Women's Medical University' ne '' ; 2. Urayasu-ekimae clinic ; 3. Saishokai memorial hospital

E-mail address corresponding author:
kimata@kc.twmu.ac.jp

Background:
In hemodialysis patients, hyperphosphatemia plays a major role in the development of secondary hyperparathyroidism. To correct hyperphosphatemia in hemodialysis patients presenting with diminished urinary phosphorus excretion, it is necessary to restrict oral phosphorus intake and use phosphorus binders. In other hand, Histamine2-receptor antagonists (H2RAs) or proton pump inhibitors (PPIs) have been the mainstay of symptom control for gastrointestinal complications, apart from frequency of use. However, In vitro, the dramatic fall in phosphorus binding by calcium carbonate at higher pH has also been shown. This observation has led to the hypothesis that GI medications (H2RAs and/or PPIs) may be associated with relationship of phosphorus control.

Methods:
We evaluated 231 patients (134 men, 86 women; mean age 63.7 +/- 13.4 years, vintage 6.3 +/- 5.5 years) who were on hemodialysis therapy. The major outcome studied was probability of hemodialysis patients having a higher phosphorus (PO4), of >5.5 mg/dl at baseline.

Results:
Adjusted odds ratio (AOR) of having PO4 >5.5 g/dl was significantly higher (p<0.05) in patients with higher GI medications use (AOR=2.23), lower spKT/V (AOR=0.84 per 0.1), and lower age (AOR=0.97 per year).

Conclusion:
This study focused upon decreasing hypercalcemia and hyperphosphatemia for reaching guideline levels and may need to decrease GI medications efforts to also maintain good phosphorus control.

Subject:
Hemodialysis

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