Sevelamer-Associated Rectosigmoid Ulcers in an End-Stage Renal Disease Patient

Abstract

Sevelamer carbonate is a commonly prescribed anion-exchange resin administered orally to prevent hyperphosphatemia in patients with chronic kidney disease. We present a rare case of a 33-year-old man with end-stage renal disease and diabetic gastroparesis on sevelamer carbonate, who presented with hematochezia and was found to have rectosigmoid ulcers induced by sevelamer crystals. His hematochezia resolved after switching from sevelamer carbonate to lanthanum carbonate. Clinicians and pathologists must be aware of the possibility of drug-induced mucosal ulceration associated with sevelamer use as a potential etiology of a gastrointestinal bleed.

Sevelamer Associated Gastrointestinal Complications in Kidney Transplant Recipients: Case Reports and Review of the Literature

“…Since FDA approval and widespread use of sevelamer as a phosphate binder in CKD patients there have been several case reports of more severe GI complications associated with the use of sevelamer including gastrointestinal bleeding, colonic ulceration, colitis, and perforated diverticulum. The majority of reports are of colonic pathology associated with sevelamer crystals, but also several cases involving upper GI or small bowel pathology [4][5][6][7][8][9][10][11][12][13][14][15][16].…”

“…In pre marketing clinical trials, GI complaints were the most common side effects of sevelamer and lead to drug discontinuation in a minority of patients [3]. In post marketing experience, there have been reports of more significant GI pathology including gastrointestinal bleeding, colonic ulceration, colitis, and perforated diverticulum in association with the use of sevelamer in CKD patients as well as the more benign side effects seen in premarketing studies [4][5][6][7][8][9][10][11][12][13][14][15][16]. GI symptoms and complications occur with some frequency in kidney transplant recipients with a complex spectrum of causes of which side effects of immunosuppression medications and infectious disease problems are contributing factors.…”

New Kids on the Block

“…[1][2][3][4][5][6][7][8][9] As detailed in this review, some agents are critical to recognize because of their association with significant background mucosal injury, such as yttrium 90 ( 90 Y) microsphereassociated radiation 1,10,11 or sodium polystyrene sulfonateor sevelamer-associated mucosal ulcers, ischemia, and pseudotumors. 8,[12][13][14][15][16][17][18][19][20][21][22] Other foreign materials are inconsequential, such as pharmaceutical fillers or bile acid sequestrants (BASs), but awareness of their typical histologic appearance is important to prevent misdiagnosis and triggering of unnecessary additional studies. 2,4,7 Recognition of these agents can also serve as a helpful clue to carefully screen for other related processes, such as prompting consideration of amyloid in patients with lanthanum carbonate deposition, sodium polystyrene sulfonate, or sevelamer, as these agents are only prescribed in the setting of renal failure.…”