Effect of sevelamer on aortic pulse wave velocity in patients on hemodialysis: A prospective observational study

Abstract

Aortic stiffening and aortic calcification are risk factors for cardiovascular events in hemodialysis (HD) patients, and these 2 risk factors are interrelated. Sevelamer decreases aortic calcification but its effect on aortic stiffness has not been investigated previously. Thirteen HD patients commencing sevelamer treatment and 13 matched controls were followed for 11 months. Aortic pulse wave velocity (PWV), augmentation index (AIx), and levels of inhibitors of vascular calcification (fetuin-A, matrix-GLA-protein, osteoprotegerin/RANKL) were measured at baseline and at the end of follow-up, and the differences between the groups were compared. Determinants of the changes in PWV during follow-up were assessed by multivariate linear regression. At baseline, PWV was 9.93 (2.10) m/s in sevelamer-treated patients and 9.20 (2.84) m/s in control patients (p=0.464). By the end of follow-up, PWV decreased by 0.83 (2.3) m/s in sevelamer-treated patients while it increased by 0.93 (1.88) m/s in controls (p=0.042). The direction of changes in AIx were similar, but not statistically significant. There were no significant differences in the levels of inhibitors of calcification either at baseline or during follow-up. In multivariate linear regression sevelamer treatment, diabetes, heart rate, and C-reactive protein were related to the change in PWV. These data suggest that sevelamer treatment is associated with an improvement in aortic stiffness in HD patients, but it does not seem to affect serum levels of inhibitors of vascular calcification.

The Ratio of Osteoprotegerin to Fetuin-A Is Independently Associated with Vascular Stiffness in Hemodialysis Patients

“…High serum OPG levels are associated with the progression of carotid atherosclerosis and coronary calcification in the general population, and a similar trend has been noted in HD patients [22,23,24]. Kim et al [25 ]reported a significant link between serum OPG levels and vascular stiffness.…”

Comparative study of methodologies for pulse wave velocity estimation

“…The PulsePen device has been previously described in details. [27][28] Herein, when the difference between heart rate recorded during the carotid measurement and that recorded during the femoral measurement was equal or greater than 10%, the PWV measurement was repeated (the difference in heart rate is indicated in the PulsePen software). According to this procedure, measurement of PWV had to be repeated in seven subjects.…”

Arterial Stiffness in Chronic Kidney Disease: The Usefulness of a Marker of Vascular Damage

“…Two small observational studies showed that the use of Sevelamer, a noncalcium-containing phosphate binder, may significantly attenuate PWV deterioration in CKD patients receiving chronic dialysis [22, 23]. In another small series of 132 patients new to dialysis, the use of Sevelamer was associated with a significant reduction in the risk of PWV increase during the first 12 months of dialysis (odds ratio: 0.86; 95%CI 0.83–0.91, P = .05) [12].…”