Effect of sevelamer on dyslipidemia and chronic inflammation in maintenance hemodialysis patients.
BACKGROUND
Hemodialysis (HD) patients often experience cardiovascular events, that might be related to altered calcium-phosphate metabolism, dyslipidemia, and chronic inflammation in addition to hypertension. Sevelamer, a non-calcium-containing phosphate binder, may improve the lipid profile of HD patients. However, the influence of sevelamer on chronic inflammation has not been clarified.


METHODS
We enrolled 36 maintenance HD patients with a serum calcium (Ca) or phosphate (P) level constantly greater than 9.5 mg/dL and 5.5 mg/dL, respectively. The dose of sevelamer was titrated to achieve a serum Ca and P in the target ranges. The study period was 24 weeks. Patients underwent the following measurements: bone mineral markers, lipids, and a high-sensitivity C-reactive protein (hs-CRP).


RESULTS
In the 28 patients who completed the study, sevelamer significantly reduced the mean non-high-density lipoprotein cholesterol (non-HDL-C) level by 15% and 20% (p < 0.0001) after 12 and 24 weeks, respectively, in addition to reducing the serum P level and Ca x P product. Similarly, there was a significant reduction of the serum hs-CRP level after 12 and 24 weeks [median at baseline: 1.03 mg/dL (interquartile range 0.26-3.98 mg/dL) versus 0.57 (0.17-1.47) and 0.38 (0.16-1.03), respectively, p = 0.0259]. The reduction rate of hs-CRP was significantly correlated with those of non-HDL-C (r = 0.451, p < 0.0401) and P (r = 0.453, p < 0.0008)


CONCLUSIONS
Hs-CRP levels were reduced by sevelamer administration, as well as non-HDL-C, P, and the Ca x P product. Sevelamer may have an anti-inflammatory effect, in addition to lowering phosphate and lipid levels in HD patients.
Yamada
Kazuhiro
K
First Department of Internal Medicine, Miyazaki Medical College, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki 8891692, Japan. kazu-yamada@msc.biglobe.ne.jp
Fujimoto
Shouichi
S
Tokura
Takeshi
T
Fukudome
Keiichi
K
Ochiai
Hideyuki
H
Komatsu
Hiroyuki
H
Sato
Yuji
Y
Hara
Seiichiro
S
Eto
Tanenao
T
D000368:Aged; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D008076:Cholesterol, HDL / Q000187:drug effects / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004852:Epoxy Compounds / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011073:Polyamines; D011095:Polyethylenes / Q000627:therapeutic use*; D011336:Probability; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D000069603:Sevelamer; D016896:Treatment Outcome; D014657:Vasculitis / Q000517:prevention & control
D008076:Cholesterol, HDL; D004852:Epoxy Compounds; D011073:Polyamines; D011095:Polyethylenes; D002097:C-Reactive Protein; D000069603:Sevelamer; D002118:Calcium