Can omeprazole reduce the incidence of hypercalcemia in dialysis patients using calcium containing phosphate binders?

Introduction: Calcium absorption from the bowel is known to depend upon gastric acidity. We chose to investigate whether the use of omeprazole could reduce the incidence of hypercalcemia in dialysis patients who could not afford expensive non-calciumbased phosphate binders.

Methods: 26 hemodialysis patients at the Hypertension, Nephrology, Dialysis, and Transplantation Clinic in Opelika, Alabama (USA) with refractory hypercalcemia for at least 3 months prior to the study who were unable to afford non-calcium-based binders were treated with 20 mg of omeprazole a day for three months and then compared to 27 similar patients who were taking non-calcium-based binders.

Results: While there was a trend towards lower serum calcium levels and phosphate binder dosages in the omeprazole group (particularly with the calcium carbonate binders as opposed to the calcium acetate binders), there was no statistical difference in any variable in either controls or the omeprazole group from pre-study period.

Conclusions: While theoretically advantageous, we found that omeprazole had little clinical benefit in reducing hypercalcemia in a population who are unable to afford non-calcium-based binders; however, further studies may be warranted.