Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients.
By Glenn M. Chertow, S. Burke, P. Raggi. Kidney International, 2002
1,491 citations recorded by the source corpus.
BACKGROUND Cardiovascular disease is frequent and severe in patients with end-stage renal disease. Disorders of mineral metabolism may contribute by promoting cardiovascular calcification. METHODS We conducted a randomized clinical trial comparing sevelamer, a non-absorbed polymer, with calcium-based phosphate binders in 200 hemodialysis patients. Study outcomes included the targeted concentrations of serum phosphorus, calcium, and intact parathyroid hormone (PTH), and calcification of the coronary arteries and thoracic aorta using a calcification score derived from electron beam tomography. RESULTS Sevelamer and calcium provided equivalent control of serum phosphorus (end-of-study values 5.1 +/- 1.2 and 5.1 +/- 1.4 mg/dL, respectively, P = 0.33). Serum calcium concentration was significantly higher in the calcium-treated group (P = 0.002), and hypercalcemia was more common (16% vs. 5% with sevelamer, P = 0.04). More subjects in the calcium group had end-of-study intact PTH below the target of 150 to 300 pg/mL (57% vs. 30%, P = 0.001). At study completion, the median absolute calcium score in the coronary arteries and aorta increased significantly in the calcium treated subjects but not in the sevelamer-treated subjects (coronary arteries 36.6 vs. 0, P = 0.03 and aorta 75.1 vs. 0, P = 0.01, respectively). The median percent change in coronary artery (25% vs. 6%, P = 0.02) and aortic (28% vs. 5%, P = 0.02) calcium score also was significantly greater with calcium than with sevelamer. CONCLUSIONS Compared with calcium-based phosphate binders, sevelamer is less likely to cause hypercalcemia, low levels of PTH, and progressive coronary and aortic calcification in hemodialysis patients.
Subfields: Nephrology, Nutrition and Dietetics, Pathology and Forensic Medicine
View Paper: https://www.semanticscholar.org/paper/203c35e775582c162b92444700ef8f39d057889f
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Citations in the corpus
- KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) (2009, background): “36 (NS); Mean whole (1-84) PTH (pmol/L): 17.”
- Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). (2011, background): “Concern about calcification due to calciumcontaining phosphate binders is increasing.(110,111) Therefore, the use of non-calcium-containing phosphate binders may be advantageous,(112) although data are insufficient to establish the comparative superiority of these agents over calcium-containing phos”
- Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. (2005, background): “First, a substantially greater proportion of patients new to dialysis had no visible coronary calcification compared to previous reports of subjects undergoing chronic hemodialysis [5].”
- Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. (2006, background): “examined survival before the routine use of sevelamer hydrochloride and paricalcitol, that is, the two most commonly used medications for the management of osteodystrophy dialysis patients in the past few years.(11) Similarly, the default dialysate calcium concentration was 3.”
- Calcium metabolism in health and disease. (2010, background): “Numerous studies of calcium-based versus calcium-free phosphate binders in patients with renal failure suggest a link between calcium use and soft tissue calcification, especially coronary vascular calcification (46).”