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Alam S, Hussain A, Daiwajna R, Tan J
Correspondence: Dr Sartaj Alam, firstname.lastname@example.org
Introduction Sevelamer hydrochloride (Renagel) is frequently used as a second-line phosphate binder in patients on renal replacement therapy. Many studies have shown that sevelamer can improve vascular calcification, serum uric acid and low-density lipoprotein (LDL) cholesterol levels. The main objectives of this study were to assess the efficacy of sevelamer against calcium-based phosphate binders, as well as its tolerability and side-effect profile.
Methods This was a retrospective study that included all patients on renal replacement therapy (between 2008 and 2011) who had previously received calcium-based binders for ≥ 6 months and were subsequently switched to sevelamer. Data collected from the patients’ medical records included demographics, as well as renal parameters three months prior to sevelamer treatment, and at three and six months post treatment. The study excluded patients on multiple, concomitant phosphate binders or with functioning renal transplants, and those who were noncompliant or had inadequate follow-up blood investigations.
Results A total of 39 patients were included in the study. No major side effects were reported by any of the patients. There were improvements in calcium, phosphate, uric acid and LDL cholesterol levels at three and six months post-sevelamer treatment.
Conclusion We found sevelamer to be superior to calcium-based phosphate binders in reducing serum calcium, phosphate, uric acid and LDL cholesterol levels in our patient population with advanced renal bone disease. Sevelamer also appears to be well tolerated with no significant side effects.
Keywords: calcium-based binders, dialysis, phosphate binders, renagel, sevelamer
Singapore Med J2013; 54(5): 263-266; http://dx.doi.org/10.11622/smedj.2013105
| 1. Melamed ML, Eustace JA, Plantinga L, et al. Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients: A longitudinal study. Kidney Int 2006; 70:351-7. |
| 2. Block GA, Port FK. Re-evaluation of risk associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: Recommendations for a change in management. Am J Kidney Dis 2000; 35:1226-37. |
| 3. Kuhlmann MK. Management of hyperphosphatemia. Hemodial Int 2006; 10:338-45. |
| 4. Amin N. The impact of improved phosphorus control: use of sevelamer hydrochloride in patients with chronic renal failure. Nephrol Dial Transplant 2002; 17:340-5. |
| 5. Mudge DW Johnson DW, Hawley CM, et al. Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice? BMC Nephrol 2011; 12:20. |
| 6. Hutchinson AJ, Smith CP, Brenchley PE. Pharmacology, efficacy and safety of oral phosphate binders. Nat Rev Nephrol 2011; 7:578-89. |
| 7. Chertow GM, Burke SK, Raggi P, Treat to Goal Working Group. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int 2002; 62:245-52. |
| 8. Qunibi W Moustafa M, Muenz LR, et al. A 1 year randomised trial of calcium acetate versus sevelamer on progression of coronary artery calcification in haemodialysis patients with comparable lipid control: the Calcium Acetate Renagel Evaluation-2 (CARE-2) study. Am J Kidney Dis 2008; 51:952-65. |
| 9. Block GA, Spiegel DM, Ehrlich J, et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int 2005; 68:1815-24. |
| 10. Block GA, Raggi P, Bellasi A, Kooienga L, Spiegel DM. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 2007; 71:438-41. |
| 11. Russo D, Miranda I, Ruocco C, et al. The progression of coronary artery calcification in predialysis patients on calcium carbonate or sevelamer. Kidney Int 2007; 72:1255-61. |
| 12. St Peter WL, Liu J, Weinhandl E, Fan Q. A comparison of sevelamer and calcium-based phosphate binders on mortality, hospitalization, and morbidity in hemodialysis: a secondary analysis of the Dialysis Clinical Outcomes Revisited (DCOR) randomized trial using claims data. Am J Kidney Dis 2008; 51:445-54. |
| 13. Garg JP, Chasan-Taber S, Blair A, et al. Effects of sevelamer and calciumbased phosphate binders on uric acid concentrations in patients undergoing hemodialysis: A randomized clinical trial. Arthritis Rheum 2005; 52:290-5. |
| 14. Shantouf R, Budoff MJ, Ahmadi N, et al. Effects of sevelamer and calcium-based phosphate binders on lipid and inflammatory markers in hemodialysis patients. Am J Nephrol 2008; 28:275-9. |
| 15. Ferramosca E, Burke S, Chasan-Taber S, et al.: Potential antiatherogenic and anti-inflammatory properties of sevelamer in maintenance hemodialysis patients. Am Heart J 2005; 149:820-5. |
| 16. Ohno I, Yamaguchi Y, Saikawa H, et al. Sevelamer decreases serum uric acid concentration through adsorption of uric acid in maintenance hemodialysis patients. Intern Med 2009; 48:415-20. |
|17. Shaheen FA, Akeel NM, Badawi LS, Souqiyyeh MZ. Efficacy and safety of sevelamer. Comparison with calcium carbonate in the treatment of hyperphosphatemia in hemodialysis patients. Saudi Med J 2004; 25:785-91.|
| 18. Lieu YL, Lin HH, Yu CC, et al. A comparison of sevelamer hydrochloride with calcium acetate on biomarkers of bone turnover in hemodialysis patients. Ren Fail 2006; 28:701-7. |
|19. Chow KM, Szeto CC, Kwan BC, Leung CB, Li PK. Sevelamer treatment strategy in peritoneal dialysis patients: conventional dose does not make best use of resources. J Nephrol 2007; 20:674-82.|
|20. Lo WK, Cheng SW, Ng SY, et al. Efficacy and side effects of sevelamer hydrochloride as sole phosphate binder in peritoneal dialysis patients with severe hyperphosphatemia. Perit Dial Int 2008; 28:93-5.|
| 21. Gulati A, Sridhar V, Bose T, Hari P, Bagga A. Short-term efficacy of sevelamer versus calcium acetate in patients with chronic kidney disease stage 3-4. Int Urol Nephrol 2010; 42:1055-62. |
| 22. Lin YF, Chen YM, Hung KY, et al. Benefits of sevelamer on markers of bone turnover in Taiwanese hemodialysis patients. J Formos Med Assoc 2010; 109:663-72. |