Comparison of calcium acetate with calcium carbonate as phosphate binder in patients on maintenance haemodialysis

Hyperphosphatemia is common in end-stage renal disease patients. Objective of this study is to compare the hypercalcaemic effect and phosphate binding power of calcium acetate and calcium carbonate in end-stage renal disease patients on maintenance haemodialysis. This randomised control trial was conducted in four phases with calcium acetate or calcium carbonate. Sixty-four patients on haemodialysis were randomly divided into 2 groups. After a washout period of 2 weeks, each group was given calcium acetate or calcium carbonate for 2 months. After another washout period the patients were crossed over and again received these drugs for 2 months. Serum Calcium, phosphate, and albumin were analysed on Selectra E auto analyser at completion of each phase of study. Hypercalcaemic effect was defined as serum calcium >2.54 mmol/l, and phosphate binding power as serum phosphate <1.61 mmol/l. Forty-one patients completed the study. Though lower dose of calcium acetate was used, it resulted in equally good control of hyperphosphatemia as compared with calcium carbonate therapy [1.37 mmol/l [SD 0.33] vs. 1.46 mmol/l [SD 0.34], p=0.16]. Incidence of hypercalcaemia was higher with calcium carbonate therapy [2.73 +/- 0.67 mmol/l vs. 2.32 +/- 0.28 mmol/l, p < 0.01]. Both drugs were well tolerated, but patients more frequently complained of muscle cramps while taking calcium acetate. It is concluded that calcium acetate has similar effect on serum phosphate levels as compared to calcium carbonate in patients on maintenance haemodialysis. However, calcium acetate results in lesser frequency of hypercalcaemia as compared to calcium carbonate. Tolerance to both drugs was similar, though patients complained of more muscle cramps while taking calcium acetate

Assessment of lipid dysfunction in patients on maintenance haemodialysis

Dyslipidaemia is a major risk factor of cardiovascular disease in patients on maintenance haemodialysis. Both increased and decreased levels of cholesterol are associated with increased cardiovascular mortality in haemodialysis patients. To assess the lipid dysfunction among patients on maintenance haemodialysis in a nephrology unit at Rawalpindi as compared with healthy individuals. A descriptive comparative study was carried out in a nephrology unit at Rawalpindi, Pakistan. A total of 140 subjects were included consisting of 70 patients on maintenance haemodialysis [MHD] and 70 healthy controls. Body mass index [BMI] was measured according to WHO guidelines. Serum total cholesterol [TC], triglycerides [TG] and high-density lipoprotein cholesterol [HDL-C] were assayed on chemistry analyser. Low-density lipoprotein cholesterol [LDL-C] was calculated by Friedwald equation. MHD patients had significantly lower BMI, mean [SD] 20.07[3.66] as compared with the controls 22.88[3.97] kg/m2 [p < 0.001]. The lipid profile among MHD patients and controls are given as mean [SD]: [a] Total Cholesterol 3.84[1.06] vs 4.65[0.97] [p < 0.001], [b] LDL-C 2.21[0.77] vs 2.93[0.71] [p < 0.001], [c] HDL-C 0.95[0.166] vs 0.97[0.138] [p=NS], [d] Non HDL 2.88[0.95] vs 3.67[0.88] [p < 0.0001], [e] Triglycerides 1.68[1.09] vs 1.69[0.86] [p=NS]. The most common abnormality observed in haemodialysis patients was low HDL-C [81%] followed by increased Non-HDL-C [23%] and increased serum triglycerides [19%]. It is concluded that our patients on maintenance haemodialysis have significantly low BMI, total Cholesterol, LDL-C and Non-HDL-C depicting malnutrition leading to inflammation, accelerated atherosclerosis process and cardiovascular complications

Spontaneous bacterial peritonitis

To evaluate the prevalence, diagnostic criteria and microbial spectrum of spontaneous bacterial peritonitis [SBP] and its variants in cirrhotic patients with ascites. A hospital based prospective study carried out in cirrhotic patients with ascites. The study was conducted in the Department of Medicine Military Hospital Rawalpindi during October 2000 to March 2002. One hundred and eighty consecutive patients of cirrhotic liver between the ages of 20-65 years presenting with ascites reporting to outdoor patient department of Military Hospital Rawalpindi were included in the study. The diagnosis of cirrhosis was made on history, clinical examination and the ultrasonographic findings. These patients were subjected to ascites fluid tap and the patients were divided into SBP and non-SBP groups in the light of results of ascitic fluid routine examination and culture. The SBP group was further categorized into culture positive SBP, culture ne gative neutrocytic ascites [CNNA] and bacterascites [BA] on the basis of culture results and total leukocyte count, absolute polymorphonuclear leukocyte count per cubic mm of ascitic fluid. The study included 144 males and 36 females having cirrhosis with ascites. The mean age of these patients was 52.32 +/- 7.87 years. On the basis of routine examination and culture of tapped ascitic fluid from these cases 57 of 180[31.66%] patients were diagnosed to have SBP or its variants, In addition to classic SBP in 18[31.58%] patients, its variants namely culture negative neutrocytic ascites and bacterascites were detected in 37[64.92%] and two [3.5%] cases respectively. E. coli was the most frequently cultured organism. It was isolated in 12 cases of SBP [60%]. In 4 cases [20%] Klebsiella was cultured whereas Proteus mirabilus and Streptococcus were reported in two cases [10%] each. This study indicates that spontaneous bacterial peritonitis is common and potentially fatal complication in cirrhotic patients with ascites. E. coli is the most frequent offending organism