Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders

Abstract

The use of sevelamer as an add-on or alternative therapy to calcium-based phosphate binders is associated with improved survival in patients on maintenance hemodialysis.

Management of Hyperphosphatemia in End-Stage Renal Disease: A New Paradigm

“…75,76 However, sevelamer can have adverse GI effects with a high pill burden and binds to fat-soluble vitamins, thereby reducing its bioavailability. 62,72,77 Lanthanum carbonate, another non-calcium-based binder, has high phosphate-binding affinity, low pill burden, and works over a wide range of pH with no negative effects on bone; however, it is expensive, can produce adverse GI effects, and has uncertain long-term effects on the liver and nervous tissues because of systemic absorption and is difficult to chew. 62,72,73 To optimize use, doses of phosphate binders may be titrated up or down or removed from the treatment plan based on serial serum phosphorus levels and timing of meals.…”

“…85,86 Paricalcitol is an analog with a wider therapeutic window but similar efficacy and safety as calcitriol. 77,78 Doxercalciferol is an analog of vitamin D 2 and undergoes hydroxylation in the liver to become active, without involvement of the kidney. 80…”

Plant-Based Diets in CKD

“…On the basis of the importance of phosphorus restriction in patients with CKD, pharmacotherapy has been used to reduce hyperphosphatemia. In a retrospective cohort analysis of the Dialysis Outcomes and Practice Patterns Study, noncalcium-based phosphate binders were associated with a 14% risk reduction in mortality (8). The authors hypothesized that phosphate binder treatment may have allowed dietary phosphorus restrictions to be relaxed, leading to better nutritional intake and improved survival.…”

Медикаментозная Коррекция Нарушений Фосфатно-Кальциевого Обмена У Пациентов С Хронической Болезнью Почек И Минерально-Костной Болезнью

“…В другом исследовании приводились интересные данные о том, какой эффект производит назначение севеламера как дополнительного препарата в комби-нированной терапии или альтернативного в качестве монотерапии для пациентов с ХБП-МКБ, которые уже принимали кальцийсодержащие препараты [15]. В рамках этого анализа изучались данные 12 564 находя-щихся на диализе пациентов 3-й фазы уже упомянуто-го исследования DOPPS [8].…”