Sevelamer carbonate reduces the risk of hypomagnesemia in hemodialysis-requiring end-stage renal disease patients

Abstract

BackgroundSevelamer has been associated with less progression of vascular calcifications. This effect could be due to a reduction in serum phosphate levels but also to other additive effects. Magnesium has been also shown to prevent vascular calcification but the effect of sevelamer on serum magnesium levels has not been thoroughly evaluated. Our aim was to analyze whether the use of sevelamer reduces the risk of hypomagnesemia in hemodialysis (HD)-requiring end-stage renal disease patients.MethodsAll prevalent patients from the dialysis unit of the Hospital Italiano de Buenos Aires as of 1 June 2015 were evaluated. They were on three times per week bicarbonate/citrate-buffered HD. They were not receiving phosphate binders or magnesium-containing drugs. The average of three successive monthly magnesium serum levels was considered as the baseline magnesium concentration. Sevelamer carbonate use was retrieved from the patient's clinical records.ResultsOne hundred and fifty-one patients were included. A large proportion of individuals were on proton pump inhibitors (PPIs) (66%) and more than 50% were using sevelamer carbonate. Serum magnesium levels were significantly higher in those receiving sevelamer compared with those who did not (2.05 ± 0.3 versus 1.8 ± 0.4 mg/dL; P < 0.05). A larger proportion of individuals receiving sevelamer were among those with normal serum magnesium (P = 0.02), while among those with hypomagnesemia, a larger proportion were on PPIs. In the multivariate model including the use of PPIs, sevelamer carbonate resulted in an independent protective factor for hypomagnesemia (odds ratio: 0.44; 95% confidence interval: 0.21–0.87).ConclusionsHemodialysis patients receiving sevelamer show higher serum magnesium levels and a reduced risk of hypomagnesemia. This effect remains even after adjustment for PPI use. This effect could contribute to the still controversial superiority of sevelamer in preventing vascular calcifications.

Cardiovascular disease, mortality, and magnesium in chronic kidney disease: growing interest in magnesium-related interventions

“…[85]. In addition, two cross-sectional studies showed an independent relationship between sevelamer and higher serum Mg levels [36,86]. It seems plausible to speculate that this effect of sevelamer depends on its adsorptive action on some substances other than P. Free fatty acids in the intestinal lumen may combine with Mg to form non-absorbable soaps.…”

Comparison of sevelamer and calcium carbonate in prevention of hypomagnesemia in hemodialysis patients

“…Their study showed the protective properties of sevelamer against hypomagnesemia, even considering the effects of PPI, although their findings questioned the effectiveness of sevelamer in the prevention of calcification. [ 4 ]…”

“…Recent studies have shown that hypomagnesemia can be one of the causes of CKD and lead to increased cardiovascular mortality in patients with ESRD (requiring dialysis). [ 4 ]…”

“…Serum magnesium levels in dialysis patients depend on magnesium intake, nutritional status (serum albumin), dialysis dose, and magnesium concentration in dialysis. [ 4 ]…”

“…studied the effect of sevelamer on serum magnesium levels in dialysis patients and reported that this drug prevented hypomagnesemia. [ 4 ] De-Francisco et al . investigated the effect of sevelamer on serum levels of magnesium and calcium and concluded that this drug increased both magnesium and calcium levels in dialysis patients.…”