{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T10:15:25Z","timestamp":1789208125419,"version":"build-2803163510"},"reference-count":36,"publisher":"BMJ","issue":"6496","license":[{"start":{"date-parts":[[1985,9,7]],"date-time":"1985-09-07T00:00:00Z","timestamp":494899200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br Med J (Clin Res Ed)"],"published-print":{"date-parts":[[1985,9,7]]},"abstract":"<jats:p>Secondary hyperparathyroidism was suppressed over a period of one year in 12 children with chronic renal failure by using a regimen of mild dietary phosphate restriction and high dose phosphate binders. The patients were randomised to receive either aluminium hydroxide or calcium carbonate by mouth for six months and then crossed over to the other medication. Vitamin D (dihydrotachysterol) dosage was unchanged. Serum parathyroid hormone concentrations were reduced to within the normal range, urinary cyclic adenosine monophosphate values fell, plasma phosphate concentrations decreased, and the theoretical renal phosphate threshold increased significantly. Transiliac bone biopsy findings improved in four patients with adequate suppression of parathyroid hormone concentrations, deteriorated in two patients who were not compliant, and did not change in five patients in whom initial bone disease was mild. Growth velocity improved significantly. There was no difference in the clinical response, biochemical changes, or incidence of complications during treatment with the two agents. In view of the risk of aluminium toxicity the use of high dose calcium carbonate with dietary phosphate restriction and vitamin D supplementation is recommended in the control of secondary hyperparathyroidism in children with chronic renal failure.<\/jats:p>","DOI":"10.1136\/bmj.291.6496.623","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T11:00:59Z","timestamp":1238670059000},"page":"623-627","source":"Crossref","is-referenced-by-count":42,"title":["Suppression of secondary hyperparathyroidism in children with chronic renal failure by high dose phosphate binders: calcium carbonate versus aluminium hydroxide."],"prefix":"10.1136","volume":"291","author":[{"given":"R H","family":"Mak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Turner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Powell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G B","family":"Haycock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Chantler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1985,9,7]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Parathyroid hormone metabolism and its potential as a uremic toxin","volume":"239","author":"Slatopolsky, E.; Martin, K.; Hruska, K.","year":"1980","unstructured":"Slatopolsky E, Martin K, Hruska K. Parathyroid hormone metabolism and its potential as a uremic toxin. AmJ_ Physiol 1980;239:F1-12.","journal-title":"AmJ_ Physiol"},{"key":"ref_2","first-page":"181","article-title":"The search for uremic toxin(s) \"X\" \"X\" = PTH","volume":"11","author":"Massry, S.G.; Goldstein, D.A.","year":"1979","unstructured":"Massry SG, Goldstein DA. The search for uremic toxin(s) \"X\" \"X\" = PTH. Clin Nephrol 1979;11:181-9.","journal-title":"Clin Nephrol"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1203\/00006450-197312000-00006","article-title":"A review: short stature in renal disease","volume":"7","author":"Stickler, G.B.; Bergen, B.J.","year":"1973","unstructured":"Stickler GB, Bergen BJ. A review: short stature in renal disease. Pediatr Res 1973;7:978-82.","journal-title":"Pediatr Res"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1172\/JCI106517","article-title":"On the pathogenesis of hyperparathyroidism in chronic experimental renal insufficiency in the dog","volume":"50","author":"Slatopolsky, E.; Caglar, S.; Penell, J.P.","year":"1971","unstructured":"Slatopolsky E, Caglar S, Penell JP, et al. On the pathogenesis of hyperparathyroidism in chronic experimental renal insufficiency in the dog. J Clin Invest 1971;50:492-9.","journal-title":"J Clin Invest"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1038\/ki.1972.84","article-title":"On the prevention of secondary hyperparathyroidism in experimental chronic renal disease using proportional reduction of dietary phosphorus intake","volume":"2","author":"Slatopolsky, E.; Caglar, S.; Gradowska, J.","year":"1972","unstructured":"Slatopolsky E, Caglar S, Gradowska J, et al. On the prevention of secondary hyperparathyroidism in experimental chronic renal disease using proportional reduction of dietary phosphorus intake. Kidney Int 1972;2:147-52.","journal-title":"Kidney Int"},{"key":"ref_6","first-page":"43","article-title":"Reversal of hyperparathyroidism in response to dietary phosphorus restriction in the uremic dog","volume":"15","author":"Kaplan, M.A.; Canterbury, J.M.; Bourgoigne, J.J.","year":"1978","unstructured":"Kaplan MA, Canterbury JM, Bourgoigne JJ, et al. Reversal of hyperparathyroidism in response to dietary phosphorus restriction in the uremic dog. Kidney Int 1978;15:43-8.","journal-title":"Kidney Int"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1136\/bmj.2.6152.1610","article-title":"Dialysis encephalopathy: recovery after interruption of aluminium intake","volume":"ii:","author":"Poisson, M.; Masmaly, R.; Lebkiri, B.","year":"1978","unstructured":"Poisson M, Masmaly R, Lebkiri B. Dialysis encephalopathy: recovery after interruption of aluminium intake. Br Med Y 1978;ii:1610-1.","journal-title":"Br Med Y"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1056\/NEJM198404263101704","article-title":"Aluminium intoxication from aluminium containing phosphate binders in children with azotemia not undergoing hemodialysis","volume":"310","author":"Andreoli, S.P.; Bergstein, J.M.; Sherrand, D.J.","year":"1984","unstructured":"Andreoli SP, Bergstein JM, Sherrand DJ. Aluminium intoxication from aluminium containing phosphate binders in children with azotemia not undergoing hemodialysis. N EnglJ Med 1984;310:1079-84.","journal-title":"N EnglJ Med"},{"key":"ref_9","first-page":"425","article-title":"The effect of a high intake of calcium carbonate in normal subjects and patients with chronic renal failure","volume":"30","author":"Clarkson, E.M.; McDonald, S.J.; De Wardener, H.E.","year":"1966","unstructured":"Clarkson EM, McDonald SJ, De Wardener HE. The effect of a high intake of calcium carbonate in normal subjects and patients with chronic renal failure. Clin Sci 1966;30:425-38.","journal-title":"Clin Sci"},{"key":"ref_10","first-page":"784","article-title":"Substitution of aluminium hydroxide by high doses of calcium carbonate in patients on chronic haemodialysis: disappearance of hyperalumininaemia and equal","volume-title":"control of hyperparathyroidism. Proc Eur Dial Transplant Assoc","volume":"19","author":"Moriniere, P.H.; Roussel, A.; Tahiri, Y.","year":"1982","unstructured":"Moriniere PH, Roussel A, Tahiri Y, et al. Substitution of aluminium hydroxide by high doses of calcium carbonate in patients on chronic haemodialysis: disappearance of hyperalumininaemia and equal control of hyperparathyroidism. Proc Eur Dial Transplant Assoc 1982;19:784-7."},{"key":"ref_11","article-title":"The evaluation of a new diet for children on haemodialysis programmes","author":"Brown, H.E.","year":"1976","unstructured":"Brown HE. The evaluation of a new diet for children on haemodialysis programmes. University of London, 1976:15. (MSc thesis.)"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/S0140-6736(75)92736-1","article-title":"Nomogram for the derivation of renal threshold phosphate concentration","volume":"ii:","author":"Walton, R.J.; Bijvoet, O.L.M.","year":"1975","unstructured":"Walton RJ, Bijvoet OLM. Nomogram for the derivation of renal threshold phosphate concentration. Lancet 1975;ii:309-19.","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-1-4615-9152-8_1","article-title":"Indices for the measurement of the renal handling of phosphate","volume-title":"handling of phosphate","author":"Bijvoet, O.L.M.","year":"1980","unstructured":"Bijvoet OLM. Indices for the measurement of the renal handling of phosphate. In: Massry SG, Fleisch H, eds. Renal handling of phosphate. New York: Plenum Medical Book Co, 1980:1-37."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/0009-8981(74)90233-2","article-title":"Radioimmunoassay for human parathyroid hormone","volume":"54","year":"1974","unstructured":"Woo J, Singer FR. Radioimmunoassay for human parathyroid hormone. Clin Chim Acta 1974;54:161-8.","journal-title":"Clin Chim Acta"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/0009-8981(74)90133-8","article-title":"A simple direct assay for cyclic AMP in plasma and other biological samples using an improved competitive protein binding technique","volume":"56","author":"Tovey, K.C.; Oldham, K.G.; Whelan, J.A.M.","year":"1974","unstructured":"Tovey KC, Oldham KG, Whelan JAM. A simple direct assay for cyclic AMP in plasma and other biological samples using an improved competitive protein binding technique. Clin Chim Acta 1974;56:221-34.","journal-title":"Clin Chim Acta"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1177\/000456327401100168","article-title":"Assay of serum inorganic phosphate without deproteinisation: automated and manual micromethods","volume":"11","author":"Lawrence, R.","year":"1974","unstructured":"Lawrence R. Assay of serum inorganic phosphate without deproteinisation: automated and manual micromethods. Atnn Clin Biochem 1974;11:234-6.","journal-title":"Atnn Clin Biochem"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1136\/adc.47.254.613","article-title":"Estimation of glomerular filtration rate from plasma clearance of 51-chromium edetic acid","volume":"47","author":"Chantler, C.; Barratt, T.M.","year":"1972","unstructured":"Chantler C, Barratt TM. Estimation of glomerular filtration rate from plasma clearance of 51-chromium edetic acid. Arch Dis Child 1972;47:613-7.","journal-title":"Arch Dis Child"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1136\/adc.51.11.875","article-title":"Estimation of glomerular filtration rate from plasma creatinine concentration in children","volume":"51","author":"Counahan, R.; Chantler, C.; Ghazali, S.","year":"1976","unstructured":"Counahan R, Chantler C, Ghazali S, et al. Estimation of glomerular filtration rate from plasma creatinine concentration in children. Arch Dis Child 1976;51: 875-8.","journal-title":"Arch Dis Child"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1172\/JCI111365","article-title":"Effect of dietary phosphorus on circulating concentrations of 1,25 dihydroxy vitamin D and immunoreactive parathyroid hormone in children with moderate renal insufficiency","volume":"73","author":"Portale, A.A.; Booth, B.E.; Halloran, B.P.","year":"1984","unstructured":"Portale AA, Booth BE, Halloran BP, et al. Effect of dietary phosphorus on circulating concentrations of 1,25 dihydroxy vitamin D and immunoreactive parathyroid hormone in children with moderate renal insufficiency.. Clin Invest 1984;73:1580-9.","journal-title":"Clin Invest"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1056\/NEJM197205182862009","article-title":"On the pathogenesis of the uremic state: an exposition of the \"tradeoff hypothesis.\"","volume":"286","author":"Bricker, N.S.","year":"1972","unstructured":"Bricker NS. On the pathogenesis of the uremic state: an exposition of the \"tradeoff hypothesis.\" N Engl _r Med 1972;286:1093-9.","journal-title":"N Engl _r Med"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1172\/JCI108781","article-title":"Phosphate control and 25 hydroxycholecalciferol administration in preventing experimental renal osteodystrophy in the dog","volume":"60","author":"Rutherford, W.E.; Bordier, P.; Marie, P.","year":"1977","unstructured":"Rutherford WE, Bordier P, Marie P, et al. Phosphate control and 25 hydroxycholecalciferol administration in preventing experimental renal osteodystrophy in the dog. J Clin Invest 1977;60:332-41.","journal-title":"J Clin Invest"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1056\/NEJM197801192980302","article-title":"Preservation of function in experimental renal disease by dietary restriction of phosphate","volume":"298","author":"Ibels, L.S.; Alfrey, A.C.; Haut, L.","year":"1978","unstructured":"Ibels LS, Alfrey AC, Haut L, et al. Preservation of function in experimental renal disease by dietary restriction of phosphate. N Engi 7 Med 1978;298:122-6.","journal-title":"N Engi 7 Med"},{"key":"ref_23","first-page":"507","article-title":"Secondary hyperparathyroidism in early renal failure: role of phosphate retention (Abstract)","volume":"25","author":"Llach, F.; Massry, S.G.; Koffier, A.","year":"1977","unstructured":"Llach F, Massry SG, Koffier A, et al. Secondary hyperparathyroidism in early renal failure: role of phosphate retention (Abstract). Clin Res 1977;25:507A.","journal-title":"Clin Res"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1136\/bmj.284.6318.776","article-title":"Effect of aluminium hydroxide on serum ionixed calcium, immunoreactive parathyroid hormone, and aluminium in chronic renal failure","volume":"284","author":"Biswas, C.K.; Arze, R.S.; Ramos, J.M.","year":"1982","unstructured":"Biswas CK, Arze RS, Ramos JM, et al. Effect of aluminium hydroxide on serum ionixed calcium, immunoreactive parathyroid hormone, and aluminium in chronic renal failure. Br Med J 1982;284:776-8.","journal-title":"Br Med J"},{"key":"ref_25","first-page":"172","article-title":"Abnormal regulation of parathyroid hormone release by calcium in secondary hyperparathyroidism due to chronic renal failure","volume":"84","author":"Brown, E.M.; Wilson, R.E.; Eastman, R.C.; Pallotta, J.; Marynick, S.","year":"1982","unstructured":"Brown EM, Wilson RE, Eastman RC, Pallotta J, Marynick S. Abnormal regulation of parathyroid hormone release by calcium in secondary hyperparathyroidism due to chronic renal failure. J Clin Endocrinol Metab 1982;84:172-9.","journal-title":"J Clin Endocrinol Metab"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1111\/j.1651-2227.1980.tb07155.x","article-title":"Dialysis encephalopathy in a non-dialysed uraemic boy treated with aluminium hydroxide orally","volume":"69","author":"Nathan, E.; Pedersen, S.","year":"1980","unstructured":"Nathan E, Pedersen S. Dialysis encephalopathy in a non-dialysed uraemic boy treated with aluminium hydroxide orally. Acta Paediatr Scand 1980;69: 793-6.","journal-title":"Acta Paediatr Scand"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1542\/peds.71.1.56","article-title":"Accumulation of aluminium in a non-dialysed uremic child receiving aluminium hydroxide","volume":"71","author":"Groswold, W.R.; Reznik, V.; Mendoza, A.","year":"1983","unstructured":"Groswold WR, Reznik V, Mendoza A, et al. Accumulation of aluminium in a non-dialysed uremic child receiving aluminium hydroxide. Pediatrics 1983; 71:56-8.","journal-title":"Pediatrics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1038\/ki.1984.156","article-title":"Aluminium loading in children with chronic renal failure","volume":"26","author":"Sedman, A.B.; Miller, N.L.; Warady, B.A.; Lunn, G.M.; Alfrey, A.C.","year":"1984","unstructured":"Sedman AB, Miller NL, Warady BA, Lunn GM, Alfrey AC. Aluminium loading in children with chronic renal failure. Kidney Int 1984;26:201-4.","journal-title":"Kidney Int"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/S0022-3476(74)80003-X","article-title":"Growth in children treated with long term hemodialysis","volume":"84","author":"Broyer, M.; Kleinknecht, C.; Loriat, C.","year":"1974","unstructured":"Broyer M, Kleinknecht C, Loriat C, et al. Growth in children treated with long term hemodialysis. J Pediatr 1974;84:642-9.","journal-title":"J Pediatr"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/S0022-3476(83)80467-3","article-title":"Growth retardation and renal osteodystrophy in children with chronic renal failure","volume":"103","author":"Hodson, E.M.; Shan, P.F.; Evans, R.A.","year":"1983","unstructured":"Hodson EM, Shan PF, Evans RA, et al. Growth retardation and renal osteodystrophy in children with chronic renal failure. J Pediatr 1983;103:735-40.","journal-title":"J Pediatr"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/S0022-3476(80)80479-3","article-title":"Early diagnosis of juvenile renal osteodystrophy","volume":"97","author":"Norman, M.E.; Mazur, A.T.; Borden, I.V.S.","year":"1980","unstructured":"Norman ME, Mazur AT, Borden IVS, et al. Early diagnosis of juvenile renal osteodystrophy. J Pediatr 1980;97:226-31.","journal-title":"J Pediatr"},{"key":"ref_32","first-page":"7","volume":"11","author":"Accepted","year":"1985","unstructured":"(Accepted 11 J7une 1985)"},{"key":"ref_33","article-title":"Mechanical methods for treating cardiac arrest first attracted attention in 1920, when Schott reported that a blow to the chest restored the heart beat in a patient with an Adams-Stokes attack","unstructured":"Mechanical methods for treating cardiac arrest first attracted attention in 1920, when Schott reported that a blow to the chest restored the heart beat in a patient with an Adams-Stokes attack."},{"key":"ref_34","article-title":"Precordial thumps were once recommended widely, but then awareness grew of the possible risk of converting ventricular tachycardia to ventricular fibrillation by such manoeuvres.5 The American Heart Association now recommends a precordial thump only at the onset of ventricular tachycardia or fibrillation for patients who are being monitored.6 This manoeuvre has been deleted entirely from British first aid manuals.7","unstructured":"Precordial thumps were once recommended widely, but then awareness grew of the possible risk of converting ventricular tachycardia to ventricular fibrillation by such manoeuvres.5 The American Heart Association now recommends a precordial thump only at the onset of ventricular tachycardia or fibrillation for patients who are being monitored.6 This manoeuvre has been deleted entirely from British first aid manuals.7"},{"key":"ref_35","article-title":"Evidence for the effectiveness of these physical manoeuvres is often anecdotal. Moreover, the lack of electrocardiographic proof of their success has generated further scepticism. We therefore report our experience of cough and thump version documented as fully as possible in a prospective study carried out over one year from","year":"1983","unstructured":"Evidence for the effectiveness of these physical manoeuvres is often anecdotal. Moreover, the lack of electrocardiographic proof of their success has generated further scepticism. We therefore report our experience of cough and thump version documented as fully as possible in a prospective study carried out over one year from May 1983."},{"key":"ref_36","article-title":"From 1 May 1983 we recorded relevant information from all attempted resuscitations associated with ventricular tachycardia or fibrillation. Whenever possible electrocardiograms were obtained during resuscitation, but in many cases recordings could not be continued during therapeutic interventions","unstructured":"From 1 May 1983 we recorded relevant information from all attempted resuscitations associated with ventricular tachycardia or fibrillation. Whenever possible electrocardiograms were obtained during resuscitation, but in many cases recordings could not be continued during therapeutic interventions."}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.291.6496.623","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.291.6496.623","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T18:25:12Z","timestamp":1765477512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.291.6496.623"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1985,9,7]]},"references-count":36,"journal-issue":{"issue":"6496","published-online":{"date-parts":[[1985,9,7]]},"published-print":{"date-parts":[[1985,9,7]]}},"alternative-id":["10.1136\/bmj.291.6496.623"],"URL":"https:\/\/doi.org\/10.1136\/bmj.291.6496.623","relation":{},"ISSN":["0267-0623","1468-5833"],"issn-type":[{"value":"0267-0623","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[1985,9,7]]}}}