***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of the study was to evaluate the phosphate-binding efficacy , side effects , and cost of therapy of calcium ketoglutarate granulate as compared with calcium carbonate tablets in patients on chronic hemodialysis . The study design used was a r and omized , crossover open trial , and the main outcome measurements were plasma ionized calcium levels , plasma phosphate levels , plasma intact parathyroid hormone ( PTH ) levels , requirements for supplemental aluminum-aminoacetate therapy , patient tolerance , and cost of therapy .  Nineteen patients on chronic hemodialysis were treated with a dialysate calcium concentration of 1.25 mmol/L and a fixed alfacalcidol dose for at least 2 months . All had previously tolerated therapy with calcium carbonate .  Of the 19 patients included , 10 completed both treatment arms . After 12 weeks of therapy , the mean ( + /-SEM ) plasma ionized calcium level was significantly lower in the ketoglutarate arm compared with the calcium carbonate arm ( 4.8+/-0.1 mg/dL v 5.2+/-0.1 mg/dL ; P = 0.004 ) , whereas the mean plasma phosphate ( 4.5+/-0.3 mg/dL v 5.1+/-0.1 mg/dL ) and PTH levels ( 266+/-125 pg/mL v 301+/-148 pg/mL ) did not differ significantly between the two treatment arms . Supplemental aluminum-aminoacetate was not required during calcium ketoglutarate treatment , while two patients needed this supplement when treated with calcium carbonate . Five of 17 ( 29 % ) patients were withdrawn from calcium ketoglutarate therapy within 1 to 2 weeks due to intolerance ( anorexia , vomiting , diarrhea , general uneasiness ) , whereas the remaining 12 patients did not experience any side effects at all . The five patients with calcium ketoglutarate intolerance all had pre-existing gastrointestinal symptoms ;  four of them had received treatment with cimetidine or omeprazol before inclusion into the study . Calculations based on median doses after 12 weeks showed that the cost of the therapy in Denmark was 10 times higher for calcium ketoglutarate compared with calcium carbonate ( US$ 6.00/d v US$ 0.65/d ) . Calcium ketoglutarate may be an effective and safe alternative to treatment with aluminum-containing phosphate binders in patients on hemodialysis who are intolerant of calcium carbonate or acetate because of hypercalcemia . However , care must be exercised when dealing with patients with pre-existing gastrointestinal discomfort . Due to the high cost of the therapy , calcium ketoglutarate should be used only for selected patients Background . Sevelamer carbonate is an improved , buffered form of sevelamer hydrochloride developed for the treatment of hyperphosphataemia in CKD patients .  Sevelamer carbonate formulated as a powder for oral suspension presents a novel , patient-friendly alternative to tablet phosphate binders . This study compared the safety and efficacy of sevelamer carbonate powder with sevelamer hydrochloride tablets in CKD patients on haemodialysis . Methods . This was a multi-centre , open-label , r and omized , crossover design study . Thirty-one haemodialysis patients were r and omly assigned to either sevelamer carbonate powder or sevelamer hydrochloride tablets for 4 weeks followed by a crossover to the other regimen for an additional 4 weeks . Results . The mean serum phosphorus was 1.6 ± 0.5 mmol/L ( 5.0 ± 1.5 mg/dL ) during sevelamer carbonate powder treatment and 1.7 ± 0.4 mmol/L ( 5.2 ± 1.1 mg/dL ) during sevelamer hydrochloride tablet treatment . Sevelamer carbonate powder and sevelamer hydrochloride tablets are equivalent in controlling serum phosphorus ; the geometric least square mean ratio was 0.95 ( 90 % CI 0.87–1.03 ) . No statistically significant or clinical ly meaningful differences were observed in calcium × phosphorus product and lipid levels  between sevelamer carbonate powder and sevelamer hydrochloride tablets . Serum bicarbonate levels increased 2.7 ± 3.7 mmol/L ( 2.7 ± 3.7 mEq/L ) during sevelamer carbonate treatment . No statistically significant change in bicarbonate was observed during sevelamer hydrochloride treatment . Sevelamer carbonate powder and sevelamer hydrochloride were well tolerated during this study . Conclusions . Sevelamer carbonate powder and sevelamer hydrochloride tablets are equivalent in controlling serum phosphorus and well tolerated in CKD patients on haemodialysis . Bicarbonate levels improved only during sevelamer carbonate treatment . Sevelamer carbonate powder should provide a welcomed new option for the treatment of hyperphosphataemia for CKD patients on dialysis BACKGROUND Bone mass measurements are widely used to diagnose osteoporosis and identify patients at risk for fractures . Recent studies have shown that reduced bone mass is also predictive of all-cause and cardiovascular mortality in healthy postmenopausal women . Among chronic hemodialysis patients reduced bone mass result ing from the combined effects of age-related factors and renal osteodystrophy has been associated with vascular calcification . In this prospect i ve study , we investigated the ability of bone mass measurements to predict mortality in chronic hemodialysis patients . METHODS Eighty eight patients underwent hip bone mass measurements by dual energy x-ray absorptiometry ( DEXA ) and were followed up for a mean of 3.5 years . Eleven patients received renal transplants and were therefore excluded . Forty of the remaining patients died , predominantly due to cardiovascular causes ( 43 % ) . RESULT Cox regression analysis showed patient age , osteoporosis or osteopenia , and baseline average calcium x phosphate product ( Ca x P ) to be independently predictive of increased mortality . Patients with osteopenia or osteoporosis had a 3.3- and 4.3-fold increased risk of death , respectively . A Ca x P of > or=5.0 mmol2/L2 predicted a threefold increased risk of death . Previous renal transplantation predicted a lower mortality . CONCLUSIONS This study has shown for the first time that reduced total hip bone mass is an independent predictor of all-cause mortality among chronic hemodialysis patients . Our findings suggest that reduced bone mass and elevated Ca x P may be involved in the pathogenesis of cardiovascular disease in these patients but further research is required to investigate the possible mechanisms for these associations Background —Aortic pulse wave velocity ( PWV ) is a predictor of mortality in patients with end-stage renal failure ( ESRF ) . The PWV is partly dependent on blood pressure ( BP ) , and a decrease in BP can attenuate the stiffness . Whether the changes in PWV in response to decreases in BP can predict mortality in ESRF patients has never been investigated . Methods and Results —One hundred fifty ESRF patients ( aged 52±16 years ) were monitored for 51±38 months . From entry until the end of follow-up , the changes of PWV in response to decreased BP were measured ultrasonographically . BP was controlled by adjustment of “ dry weight ” and , when necessary , with ACE inhibitors , calcium antagonists , and /or & bgr;-blockers , in combination if necessary . Fifty-nine deaths occurred , including 40 cardiovascular and 19 noncardiovascular events . Cox analyses demonstrated that independent of BP changes , the predictors of all-cause and cardiovascular mortality were as follows : absence of PWV decrease in response to BP decrease , increased left ventricular mass , age , and preexisting cardiovascular disease . Survival was positively associated with ACE inhibitor use . After adjustment for all confounding factors , the risk ratio for the absence of PWV decrease was 2.59 ( 95 % CI 1.51 to 4.43 ) for all-cause mortality and 2.35 ( 95 % CI 1.23 to 4.41 ) for cardiovascular mortality . The risk ratio for ACE inhibitor use was 0.19 ( 95 % CI 0.14 to 0.43 ) for all-cause mortality and 0.18 ( 95 % CI 0.06 to 0.55 ) for cardiovascular mortality . Conclusions —These results indicate that in ESRF patients , the insensitivity of PWV to decreased BP is an independent predictor of mortality and that use of ACE inhibitors has a favorable effect on survival that is independent of BP changes We conducted a r and omized unblinded parallel clinical trial to compare the effectiveness , side effects and tolerance between calcium acetate ( CA ) and calcium carbonate ( CC )  in 80 stable chronic hemodialysis patients selected on the basis of their acceptable control of serum phosphorus ( P ) levels with aluminum hydroxide ( AH ) . All patients were dialyzed against the same calcium dialyzate ( 1.62 mmol/l ) . The serum analytical tests included : calcium corrected to total protein , P , PTH ( intact molecule ) and bicarbonate . The study was divided into the following periods : P0 : baseline measurements ; P1 : washout ( withdrawal of AH for 15 days ) ; P2 : r and om allocation to CA and CC treatment at doses equivalent to 75 mEq of elemental calcium , stratified according to previous doses of AH ( 2 months ) ; P3 : adjustment of doses until control P ( 2 months ) . CA was poorly tolerated in 7 patients and CC in 2 ( NS ) . The changes in serum P levels between P0 and P2 periods were lower in the CA group ( 1.73 + /- 0.25 vs. 1.80 + /- 0.50 mmol/l ; p = 0.26 ) than in the CC group ( 1.77 + /- 0.35 vs. 1.93 + /- 0.48 mmol/l ; p = 0.03 , paired t test ) . Serum calcium was hardly modified by CA ( 2.42 + /- 0.20 vs. 2.47 + /- 0.17 mmol/l ; NS ) while in the CC group , it rose significantly ( 2.40 + /- 0.12 vs. 2.55 + /- 0.22 mmol/l ; p = 0.0004 ) . There were no differences in the control of PTH or bicarbonate . ( ABSTRACT TRUNCATED AT 250 WORDS Recent in vitro and in vivo studies have shown that calcium acetate ( CaAC ) is a more effective phosphorus binder than , among other calcium salts , calcium carbonate ( CaCO3 ) . More efficient binding allows serum phosphorus to be controlled with a lower dose ; moreover , less calcium seems to be absorbed when CaAC is used . These properties could reduce the incidence of hypercalcemia ; however , in clinical practice few reports have compared these two calcium salts , and results disagree . We evaluated in a 24-week prospect i ve cross-over study the clinical efficiency of CaCO3 and CaAC in 10 selected chronic hemodialysis patients . Only 7 patients completed the study period . The patients were r and omly assigned to start treatment with one of the two calcium salts ; after 12 weeks they shifted to the other treatment . Serum analytical tests included weekly control of calcium , phosphorus , and alkaline phosphatase . PTH values ( intact molecule ) were obtained initially and at the end of every study period . The same good control of the phosphorus level ( 4.79 + /- 0.6 vs. 4.94 + /- 0.8 mg/dl ) was obtained with CaAC ( mean doses 4.1 + /- 0.3 g/day ) as with CaCO3 ( mean doses 4.01 + /- 0.8 g/day ) . The mean serum calcium levels were similar ( 10.36 + /- 0.5 vs. 10.20 + /- 0.5 mg/dl ) . The dose of elemental calcium administered was significantly less with CaAC ( 957 + /- 83 mg/day ) than with CaCO3 ( 1,590 + /- 317 mg/day ) . However , the incidence of hypercalcemia ( Ca > 11 mg/dl ) was similar during the two treatment periods ( 13 % with CaAC vs. 14 % with CaCO3 ) . Also the incidence of Ca x P products 765 was comparable ( 9.5 vs. 11.9 % ) . ( ABSTRACT TRUNCATED AT 250 WORDS Background and Aims : Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients . This is a prospect i ve study that compares the effects of calcium acetate and sevelamer on coronary calcification ( CAC ) and bone histology . Methods : 101 hemodialysis patients were r and omized for each phosphate binder and su bmi tted to multislice coronary tomographies and bone biopsies at entry and 12 months . Results : The 71 patients who concluded the study had similar baseline characteristics . On follow-up , the sevelamer group had 
    Output:
    
The effects of calcium acetate on biochemical end-points were similar to those of calcium carbonate .
Available phosphate-binding agents have been shown to reduce phosphorus levels in comparison to placebo .
However , there are insufficient data to establish the comparative superiority of novel non-calcium binding agents over calcium-containing phosphate binders for patient-level outcomes such as all-cause mortality and cardiovascular end-points in CKD