Objective To assess phosphate-binding efficacy of a new food product, bread with unusually high calcium content (Ca-bread). Design and setting A randomized parallel group trial in the university hospital outpatient dialysis unit. Patients Fifty-three randomly selected uremic patients who met the following inclusion criteria: (1) required maintenance hemodialysis treatment, (2) were not to receive vitamin D throughout the study, (3) were nondiabetic, and (4) were diagnosed with hyperphosphatemia. Intervention Fifty-three patients were randomized into 2 groups: control group (n = 26), which received calcium acetate as a phosphate binder throughout the study, and Ca-bread group (n = 27), which, after a 2-week washout period, received Ca-bread containing 2.5% of elemental calcium (by weight), which served as a phosphate binder. Bread was made using wheat flour, calcium carbonate, and fermented buttermilk. The amount of elemental calcium used as a phosphate binder was similar in both groups. Observation of both groups lasted 14 weeks. Results Mean serum phosphate concentration at randomization was 2.11 ± 0.14 mmol/L in the control group and 2.20 ± 0.13 mmol/L in the Ca-bread group. Mean serum calcium concentration at randomization was 2.12 ± 0.21 mmol/L in the control group and 2.14 ± 0.11 mmol/L in the Ca-bread group. The Ca-bread group patients' predialysis phosphate concentration decreased to a mean of 1.67 ± 0.18 mmol/L (P < .05), and their mean calcium concentration increased to 2.27 ± 0.11 mmol/L (P = NS). In the control group, neither value changed significantly from the original readings. After the hemodialysis session, the mean serum calcium concentration in the control group and the Ca-bread group increased by 7.5% and 7.9%, respectively (P = NS). Mean phosphate concentration simultaneously decreased to nearly 1/2 its original predialysis value in both groups. Ca-bread group patients saw a decrease in the mean phosphate concentration (from predialysis to postdialysis values) that was 13.8% greater than that of the control group (P = NS). Conclusion A new form of calcium-containing phosphate binder was developed: Ca-bread with an elemental calcium content of 2.5%. Ca-bread allows for effective amelioration of hyperphosphatemia without inducing hypercalcemia. Furthermore, patient compliance may increase if hyperphosphatemia can be treated by consuming bread with an elevated calcium content.
Field of Science
- 3.1 Basic medicine
- 3.2 Clinical medicine
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