Abstract
In some patients on chronic hemodialysis, serum phosphorus (P) levels were decreased during administration of Colestimide, a hypercholesterolemia drug that absorbs bile acid.
This study investigated the effectiveness of Colestimide as a phosphate binder. Serum P levels were determined before and after treatment with Colestimide for 4 weeks in 31 prospective patients and the results were as follows:
1) There was no difference in serum P levels at 4, 2, and 0 weeks before treatment, but those levels decreased significantly with Colestimide treatment from 6.1±1.1mg/dl to 5.5±1.2, 5.4±1.1 and 5.3±1.2mg/dl at 2, 3 and 4 weeks after treatment (p<0.0001 repeated measure ANOVA). Decrease in the mean serum P level was significant after 2 weeks (Dunnett multiple comparison).
2) The total serum calcium (Ca) concentration showed no significant difference at 4, 2 and 0 weeks before treatment. The total serum Ca concentration decreased significantly at 1, 2, 3, and 4 weeks after Colestimide treatment (p=0.0029 repeated measure ANOVA). The total serum Ca concentration decreased from 9.8±0.6mg/dl to 9.5±0.8mg/dl and 9.5±0.7mg/dl at 3 and 4 weeks after Colestimide treatment, respectively and the decrease was significant after 3 weeks (Dunnett multiple comparison). Blood Ca ion levels, however, were changed from 2.61±0.15mEq/l to 2.58±0.16mEq/l, showing little difference. Serum levels of total protein and albumin also showed little change after Colestimide treatment; therefore, it was suggested that the lowered total Ca level might be specifically attributed to complex Ca.
This study showed that Colestimide treatment could control serum P level without causing hypercalcemia and that it may be feasible to co-administer active vitamin D medication. Based on this study, Colestimide was highly recommended for use as a non-absorbable phosphate binder.
