BMJ 1995;311:124 (8 July)

Letters

Effect of alfacalcidol on renal bone disease in mild to moderate renal failure

Monitoring the calcium-phosphate product is important

EDITOR,--In Neveen A T Hamdy and colleagues' study of alfacalcidol in chronic renal failure, treatment with phosphate binding agents (other than 500 mg elemental calcium daily) was started only if the serum phosphate concentration was >2.2 mmol/l.1 We believe that the threshold for starting phosphate binding agents should be lower, particularly when alfacalcidol is being given to "maintain serum calcium concentration at the upper limit of the normal laboratory reference range" (2.63 mmol/l).

Metastatic calcification has long been recognised as a complication of chronic renal failure with serious vascular and other consequences, and it was suggested many years ago that the main determinant of metastatic calcification was the solubility product of calcium and phosphate in vivo.2 Subsequent estimates of this product have varied widely. Herbert et al estimated that a calcium-phosphate product >6 mmol2/l2 would result in precipitation, on the basis of in . . . [Full text of this article]


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Relevant Article

Effect of alfacalcidol on natural course of renal bone disease in mild to moderate renal failure
Neveen A T Hamdy, John A Kanis, Monique N C Beneton, Colin B Brown, Job R Juttmann, Johannes G M Jordans, Sylvie Josse, Alain Meyrier, Robert L Lins, and Ian T Fairey
BMJ 1995 310: 358-363. [Abstract] [Full Text]

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