Effect of Sevelamer and Calcium-Based Phosphate Binders on Coronary Artery Calcification and Accumulation of Circulating Advanced Glycation End Products in Hemodialysis Patients

Kakuta, Tsunekazu; Tanaka, Reika; Hyodo, Toru; Suzuki, Hajime; Kanai, Genta; Nagaoka, Mikako; Takahashi, Hiroo; Hirawa, Nobuhito; Oogushi, Yoichi; Miyata, Toshio; Kobayashi, Hiroyuki; Fukagawa, Masafumi; Saitō, Akira

doi:10.1053/j.ajkd.2010.10.055

Cited by 128 publications

(96 citation statements)

References 73 publications

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“…Eighteen trials 4,9,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] met the predefined inclusion criteria and were included in our meta-analysis ( Figure 1). The 18 trails included 3676 patients (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The 18 trails included 3676 patients (Table 1). CAC score was reported 4,9,10,[15][16][17][18][19][20][21]23,24,[27][28][29] After adjustment for the agreement between reviewers, the j coefficient on the agreement of the included studies was 0.92 (95% confidence interval 0.83 to 0.95), suggesting good agreement between reviewers in data extraction. All studies were randomized controlled trials.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies demonstrated that taking the NCBPs could reduce progression of vascular calcification and improve CKD-MBD status among HD patients. 9,10 Lanthanum carbonate (LC) and sevelamer are phosphate binders that do not contain aluminium or calcium. Studies have showed that LC and sevelamer are not only as effective as calcium-based binders, but also potentially improve bone health and helps in reduction of vascular calcification by reducing exogenous calcium.…”

Section: Introductionmentioning

confidence: 99%

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The effects of non-calcium-based phosphate binders versus calcium-based phosphate binders on cardiovascular calcification and bone remodeling among dialysis patients: a meta-analysis of randomized trials

et al. 2014

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Background: Vascular calcification significantly increases the rates of cardiovascular mortality in hemodialysis (HD) patients. Abnormalities in mineral metabolism may play a role in the pathogenesis of arterial calcification. Whether patients treated with non-calcium-based phosphate binders had reduced aortic vascular calcification compared to those treated with calcium-based phosphate binders is still unclear. Methods: We searched multiple databases for studies published through August 2013 that evaluated the effects of non-calcium-based phosphate binders (NCBP) versus calcium-based phosphate binders (CBP) on cardiovascular calcification and bone remodeling among dialysis patients. We summarized test performance characteristics with the use of forest plots, fixed and random effects models, and Egger regression test. Results: Eighteen eligible randomized controlled trials totaling 3676 patients were included. Meta-analysis results showed NCBP could significantly attenuate the progression of coronary artery calcification than CBP (WMD: À144.62, 95% CI: À285.62 to À3.63). The serum calcium levels significant lower in NCPB group than in CPB groups (WMD: À0.26, 95% CI: À0.37 to À0.14), but the serum iPTH levels were significantly higher in NCPB groups (WMD: 57.1, 95% CI: 13.42 to 100.78). The osteoid volume and osteoblast numbers were significant higher in NCPB group than in CPB group (WMD: 1.75, 95% CI: 0.78 to 2.73 for osteoid volume; WMD: 4.49, 95% CI: 1.83 to 7.15 for osteoblast numbers). The Egger regression test also showed no potential publication bias (p ¼ 0.725). Conclusions: Based on available data, NCBPs have equally effective with CBPs for serum phosphate control. But there was significantly lower incidence of coronary artery calcification and a significant higher bone formatting rate in NCBP groups than in CBP groups. So we recommend NCBPs as phosphate binders for HD patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effects of non-calcium-based phosphate binders versus calcium-based phosphate binders on cardiovascular calcification and bone remodeling among dialysis patients: a meta-analysis of randomized trials

et al. 2014

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“…21,22 The cost-offset model we present here suggests yet another method with which to evaluate phosphate binders and treatment costs -through the potential for reduced ESA and IV iron utilization in the dialysis clinic. Further studies, including long-term analyses, will be needed to demonstrate that our cost-offset model is accurate and that potential reduced dosing of anemia medications with ferric citrate provides benefits to patients.…”

Section: Discussionmentioning

confidence: 99%

Reduced Use of Erythropoiesis-Stimulating Agents and Intravenous Iron With Ferric Citrate: A Managed Care Cost-Offset Model

2012

American Journal of Kidney Diseases

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Background: Ferric citrate (FC) is a phosphate binder in development for the treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD). In clinical trials, FC improved patient serum phosphorus levels and increased serum ferritin and percent transferrin saturation. Because nephrologists respond to increases in these iron measures by reducing intravenous (IV) iron and erythropoiesis-stimulating agent (ESA) doses, the decreased use of iron and ESA associated with FC may reduce costs. Objectives: To develop a cost-offset model from a managed care perspective estimating the cost savings associated with FC use. Methods: We created a cost-offset model from the managed care payer perspective that compared the treatment costs of ESRD for patients given FC. The model considered the number of dialysis sessions per month; number of ESRD patients enrolled in the health plan; cost of ESAs, iron, and dialysis sessions; and the proportion of patients on phosphate binder therapy. The model assumed equivalent efficacy and cost neutrality between FC and other phosphate binders. Monte Carlo simulations were conducted by varying model inputs. Results: When FC was compared to other phosphate binders, the monthly cost of ESA and IV iron per 500 patients with ESRD (85% treated with phosphate binders) was reduced by 8.15% and 33.2%, respectively. When incorporated into the total cost of dialysis for patients with ESRD (dialysis, ESA, and IV iron), the decrease in the monthly cost of dialysis care was US$80,214 per 500 ESRD patients. Monte Carlo simulations suggest that a plan serving 500 dialysis patients could save between US$626,000 and US$1,106,000 annually with the use of FC. Conclusion: The use of FC in ESRD patients with hyperphosphatemia may help reduce treatment costs.

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“…Newer non-calcium containing phosphate binders including sevelamer and lanthanum may have favorable impact on vascular calcification. In three randomized controlled trials in hemodialysis patients, sevelamer and lanthanum attenuated the progression of CAC compared to calcium-containing phosphate binders [20][21][22] . The mortality benefits of both drugs were observed only in a subgroup of patients older than 65 years of age [23,24] .…”

Section: Non-calcium Containing Phosphate Bindersmentioning

confidence: 99%

Lowering vascular calcification burden in chronic kidney disease: Is it possible?

Disthabanchong

2013

WJN

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High prevalence of atherosclerosis and arterial calcification in chronic kidney disease is far beyond the explanation by common cardiovascular risk factors such as aging diabetes, hypertension and dyslipidemia. The magnitude of coronary artery calcification is independently and inversely associated with renal function. In addition to cardiovascular risk factors, other chronic kidney diseaserelated risks such as phosphate retention, excess of calcium and prolonged dialysis vintage also contribute to the development of vascular calcification. Strategies to lower vascular calcification burden in chronic kidney disease population should include minimizing chronic kidney disease and atherosclerotic risk factors. Current therapies available are non-calcium containing phosphate binders, low dose active vitamin D and calcimimetic agent. The role of bisphosphonates in vascular calcification in chronic kidney disease population remains unclear. Preliminary data on sodium thiosulfate are promising, however, larger studies on efficacy and patient outcomes are necessary. Several large randomized controlled trials have confirmed the lack of benefit of statin in attenuating the progression of vascular calcification.

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Effect of Sevelamer and Calcium-Based Phosphate Binders on Coronary Artery Calcification and Accumulation of Circulating Advanced Glycation End Products in Hemodialysis Patients

Cited by 128 publications

References 73 publications

The effects of non-calcium-based phosphate binders versus calcium-based phosphate binders on cardiovascular calcification and bone remodeling among dialysis patients: a meta-analysis of randomized trials

The effects of non-calcium-based phosphate binders versus calcium-based phosphate binders on cardiovascular calcification and bone remodeling among dialysis patients: a meta-analysis of randomized trials

Reduced Use of Erythropoiesis-Stimulating Agents and Intravenous Iron With Ferric Citrate: A Managed Care Cost-Offset Model

Lowering vascular calcification burden in chronic kidney disease: Is it possible?

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