Complementary Alternative Cardiovascular Medicine

Chapter 12 / Chelation Therapy and CVD 197
lean body mass, creatinine clearance, and infusion rate minimizes toxicity
(47). Liberal fluid intake is encouraged to reduce the risk of renal
injury. Nephrotoxicity is reversible and responds promptly to EDTA
treatment cessation. A conservative approach would be to advise
patients with a serum creatinine above 2.5 mg/dL to avoid chelation
therapy.
Patients with congestive heart failure (CHF) are at risk for clinical
decompensation that could occur secondary to fluid and sodium (sodium
ascorbate in the infusion) overload or from the negative inotropic effect
of transient hypocalcemia induced by EDTA. Patients with mild compensated
CHF can be managed successfully, with attention to restricting
iv fluid volume and additional diuretic therapy, if necessary. However,
with moderate to severe left ventricular dysfunction, it is best to avoid
EDTA chelation therapy.
Patients who are receiving anticoagulation therapy with warfarin can
safely receive chelation therapy. Pregnancy, known allergy to EDTA,
and active liver disease represent contraindications. A summary of
contraindications to EDTA chelation therapy is shown in Table 1.
The toxicity of EDTA chelation therapy, apart from the potential for
nephrotoxicity, is minimal. Relatively common symptoms during a
course of treatment include fatigue and muscle cramping. Correcting
mineral deficiencies usually alleviates these symptoms. Mild hypocalcemia
is particularly common. Hypoglycemia may occur during treatment,
particularly in patients who are calorically deprived before
receiving an infusion. Transient hypocalcemia induced by chelation has
the potential to induce arrhythmias; however, clinically this is exceedingly
uncommon.
Treatment Protocol
A treatment course of chelation therapy usually consists of a series of
30–40 iv infusions of disodium magnesium EDTA, adjusted for appropriate
osmolality and buffered with sodium bicarbonate. The most common
solution contains 3 g (or 50 mg/kg) of EDTA in 500 mL of sterile
water, which is infused for 3 h and administered weekly. Typically, 2 g
of magnesium chloride, 7 g of ascorbic acid, and the B vitamins thiamine,
pantothenic acid, and pyridoxine are added.
CONCLUSIONS
For 40 yr, EDTA chelation therapy for vascular disease has remained
controversial and of unproven clinical benefit. Hundreds of thousands of
Americans expose themselves to treatment with EDTA chelation
therapy. If this therapy proves helpful, then additional as-yet-untreated