Switching from Calcium Carbonate to Sevelamer Hydrochloride Has Suppressive Effects on the Progression of Aortic Calcificationin Hemodialysis Patients: Assessment Using Plain Chest X-Ray Films

Abstract

Sevelamer hydrochloride, a non-aluminum-and non-calciumcontaining hydrogel, is an effective phosphate binder in dialysis patients. The suppressive effect of the switching from calcium carbonate to sevelamer hydrochloride on the progression of vascular calcification was examined by measuring areas of calcification on routine chest X-rays using image-analyzing software. The data of 69 maintenance hemodialysis patients were analyzed retrospectively. Over a period of 18 months, 19 patients took only sevelamer hydrochloride as a phosphate binder, while the other 50 patients took only calcium carbonate. The area of calcification increased in the calcium carbonate group, but did not change significantly in the sevelamer group. While the usefulness of computed tomography in detecting vascular calcification in hemodialysis patients has been reported previously, the suppressive effects of switching from calcium carbonate to sevelamer hydrochloride on the progression of aortic calcification can be observed without computed tomography by using the plain chest X-ray films that are routinely performed in hemodialysis clinics.

Lanthanum Carbonate Delays Progression of Coronary Artery Calcification Compared With Calcium-Based Phosphate Binders in Patients on Hemodialysis

“…20 Furthermore, recent studies have indicated that hyperphosphatemia itself is an important source of inflammation and may contribute to high cardiovascular risk in patients on HD. 21 Unfortunately, the removal of Pi by current dialysis methods is insufficient to maintain Pi levels within the recommended target range, and the majority of patients on HD require oral Pi binders. Aluminum hydroxide is a first-generation Pi binder that displays excellent Pi absorption, 22 but it has been known to cause various problems, including aluminum-associated encephalopathy and osteopathy, in patients undergoing dialysis.…”

Evaluation of Morbidity and Mortality Data Related to Cardiovascular Calcification from Calcium‐Containing Phosphate Binder Use in Patients Undergoing Hemodialysis

“…10 Patients who have uremia have been shown, with EBCT and at autopsy, to possess more calcified coronary plaques compared with patients with no uremia. 14 Plain chest radiographs have also been used to identify calcifications in some patients 15 ; however, EBCT seems to be one of the preferred methods for quantifying vascular calcifications in study patients. The EBCT technique can better differentiate various stages and advancements of calcification in cardiac and valvular tissues as well as calcified coronary artery plaques compared with other imaging techniques.…”

Impact of vascular calcification on cardiovascular mortality in hemodialysis patients: clinical significance, mechanisms and possible strategies for treatment

“…Other studies also provided the link between micro-inflammation and progression of CAC [24,74,75]. It has now been known that hyperphosphatemia itself is an important source of inflammation [76]. Inflammatory cytokine TNF-α upregulates Pit-1 expression and Na-Pi co-transporter and increases phosphate uptake into VSMCs [77].…”