[Critical appraisal of sevelamer for the treatment of hyperphosphatemia in patients with chronic renal failure].
OBJECTIVE
To evaluate in patients with chronic renal failure (CRF) the effectiveness and the costs of sevelamer, a cationic polymer calcium- and aluminum-free, that is a new gastrointestinal phosphate binder.


METHODS
Literature review and critical appraisal of six clinical trials about the effectiveness and two economic studies of sevelamer in CRF patients.


RESULTS
Sevelamer is an effective phosphate binder (used in a mean daily dose of 3.5 g three times per day with meals) and with similar effect as that obtained with calcium salts, without the adverse manifestations of the latter (elevation of calcium x phosphorus product, hypercalcemia, vascular and cardiac calcifications, etc.). Moreover, sevelamer reduced serum LDL cholesterol in around 30%. Despite the greater direct costs of sevelamer compared with calcium salts, the total costs may be lower due to the reduction of costs with clinical complications and hospitalizations.


CONCLUSIONS
Sevelamer has important therapeutic value in CRF patients with hyperphosphatemia. Economic analyses should be performed in our setting to define the cost-effectiveness relationship of sevelamer.
Grupo Interdepartamental de Epidemiologia Clínica, Centro Paulista de Economia de Saúde, Escola Paulista de Medicina, Universidade Federal de São Paulo, S. Paulo, SP, Brasil. rsesso@nefro.epm.br
Ricardo
R
Sesso
Marcos B
MB
Ferraz
D002118:Calcium / Q000378:metabolism; D002986:Clinical Trials as Topic; D004852:Epoxy Compounds / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy*; D010710:Phosphates / Q000378:metabolism; D010760:Phosphorus Metabolism Disorders / Q000188:drug therapy* / Q000209:etiology; D011073:Polyamines; D011095:Polyethylenes / Q000191:economics / Q000627:therapeutic use*; D006435:Renal Dialysis; D000069603:Sevelamer
D004852:Epoxy Compounds; D010710:Phosphates; D011073:Polyamines; D011095:Polyethylenes; D000069603:Sevelamer; D002118:Calcium