Effects of Sevelamer on the Progression of Vascular Calcification in Patients on Chronic Haemodialysis

Abstract

Background/Aim: Vascular calcification is thought to be associated with a high cardiovascular mortality rate in patients with end-stage renal disease. Control of hyperphosphataemia is important for the treatment of the vascular calcification. The aim of the present study was to evaluate the effects of sevelamer hydrochloride on the progression of aortic calcification in haemodialysis (HD) patients. Methods: 42 HD patients were studied in this study and divided into two groups (sevelamer vs. calcium). Sevelamer was added and titrated up to achieve serum P control for 6 months. The estimations of aortic calcification index (ACI) by abdominal computed tomography scans were performed twice in each patient. We compared the changes in serum calcium, phosphorus, intact parathyroid hormone, and lipids in two groups. Results: Serum phosphorus levels decreased significantly from 6.7 ± 0.7 to 6.2 ± 0.5 mg/dl with no changes in serum intact parathyroid hormone levels in the sevelamer group (p < 0.01), and increased from 6.5 ± 1.0 to 6.7 ± 1.1 mg/dl in the calcium group (p < 0.05). Serum calcium levels did not change in the sevelamer group and calcium group. The serum levels of total cholesterol decreased significantly from 158.5 ± 20.7 to 146.2 ± 24.1 mg/dl (p = 0.024) and the low-density lipoprotein cholesterol level from 65.3 ± 14.4 to 54.7 ± 11.6 mg/dl (p = 0.014) in the sevelamer group. Serum C-reactive protein decreased significantly from 0.14 ± 0.13 to 0.08 ± 0.11 mg/dl in the sevelamer group (p = 0.038) and significantly increased (0.18 ± 0.09 vs. 0.22 ± 0.12 mg/dl) in the calcium group (p = 0.042). The mean changes in ACI (ΔACI) were 3.6 ± 1.5% in the sevelamer group and 8.2 ± 3.1% in the calcium group. Conclusions: Sevelamer allows a better serum phosphorus control compared with calcium-based phosphate binder and suppresses the progression of aortic calcification in HD patients.

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

“…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).…”

“…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.…”

Meta-Analysis Comparing Sevelamer and Calcium-Based Phosphate Binders on Cardiovascular Calcification in Hemodialysis Patients

“…Figure 1 shows the reasons for exclusion of 20 of these reports. Ultimately, we included 14 trials, all performed between 1999 and 2008, that enrolled a total of 3,271 HD patients [15,16,17,18,19,20,21,22,23,24,25,26,27,28]. None of the conference abstracts met the inclusion criteria and therefore were not included for analysis.…”

“…Multiple publications were excluded from the count of included studies because they were secondary publications of previous reports; however, any relevant and unique results were extracted and included. They compared sevelamer with either calcium acetate [18,20,21,24,25,26] or calcium carbonate [19,22,23,27,28] or both (based on physician preference) [15,16,17]. The treatment durations ranged from 8 weeks to 45 months.…”

Dietary and Pharmacological Control of Calcium and Phosphate Metabolism in Dialysis Patients

“…Slowing the progression of VC would be a desirable goal, since clinical reversibility has not been proven yet [143,159] . Several careful prospective randomized studies performed in both prevalent and incident hemodialysis patients [19,20,160] , although not all studies [57] , have demonstrated that sevelamer attenuates the progression of coronary and aortic artery calcifications as compared with calcium-based phosphorus binders. The TTG (Treat to Goal) and RIND studies showed also that the baseline calcification burden is one of the most important predictors of the rate of progression.…”