Potential antiatherogenic and anti-inflammatory properties of sevelamer in maintenance hemodialysis patients.
BACKGROUND
Patients affected by end-stage renal disease (ESRD) demonstrate a very high cardiovascular risk mediated by traditional cardiovascular risk factors as well as abnormal mineral metabolism and a state of chronic inflammation. Sevelamer is a nonabsorbable non-calcium-based hydrogel with potential antiatherosclerotic properties.


RESULTS
One hundred eight patients undergoing maintenance hemodialysis were randomized to sevelamer or calcium acetate as treatment for hyperphosphatemia. A coronary artery calcium score, as a measure of plaque burden, was calculated at baseline and 1 year, along with serial measurements of serum lipoproteins, beta2-microglobulin, and high-sensitivity C-reactive protein (hs-CRP). At 1 year, coronary artery calcium score progressed significantly from baseline in calcium acetate-treated subjects ( P < .001) but not in sevelamer-treated patients (P = NS). Total cholesterol (P < .0001), low-density lipoprotein cholesterol (P < .0001), apolipoprotein B (P < .0001), beta2-microglobulin (P = .018), and hs-CRP (P < .002) decreased, and high-density lipoprotein increased significantly (P = .036) from baseline in the sevelamer-treated subjects but not in subjects treated with calcium acetate despite the more frequent use of statins in the latter group (46% vs 22%, P < .05). The changes in total and low-density lipoprotein cholesterol, apolipoprotein B, and hs-CRP were significantly different between treatment groups (all P < .01).


CONCLUSIONS
Sevelamer leads to favorable changes in lipids and inflammatory markers with potentially useful antiatherogenic effects in hemodialysis patients.
Ferramosca
Emiliana
E
Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, La 70112, USA.
Burke
Steven
S
Chasan-Taber
Scott
S
Ratti
Carlo
C
Chertow
Glenn M
GM
Raggi
Paolo
P
D000085:Acetates / Q000627:therapeutic use; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D017610:Calcium Compounds; D003324:Coronary Artery Disease / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006710:Homocysteine / Q000097:blood / Q000187:drug effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008074:Lipoproteins / Q000097:blood / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D010760:Phosphorus Metabolism Disorders / Q000188:drug therapy*; D011073:Polyamines / Q000627:therapeutic use*; D006435:Renal Dialysis; D000069603:Sevelamer; D001613:beta 2-Microglobulin / Q000097:blood / Q000187:drug effects
D000085:Acetates; D000893:Anti-Inflammatory Agents; D017610:Calcium Compounds; D005343:Fibrinolytic Agents; D008074:Lipoproteins; D010710:Phosphates; D011073:Polyamines; D001613:beta 2-Microglobulin; D006710:Homocysteine; D002097:C-Reactive Protein; D000069603:Sevelamer; C120662:calcium acetate