Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis.
BACKGROUND
Hemodialysis patients are at increased risk for progressive coronary artery calcification; however, the development and progression of this disease process in patients new to hemodialysis is unknown.


METHODS
One hundred and twenty-nine patients new to hemodialysis were randomized to receive calcium containing phosphate binders or the noncalcium phosphate binder sevelamer hydrochloride. Subjects underwent electron beam computed tomography scanning (EBCT) at entry into the study and again at 6, 12, and 18 months.


RESULTS
One hundred and nine patients underwent baseline and at least one additional assessment of coronary calcification. At baseline, 37% of sevelamer treated and 31% of calcium treated patients had no evidence of coronary calcification. No subject with a zero coronary artery calcium score (CACS) at baseline progressed to a CACS >30 over 18 months. Subjects with a CACS > 30 at baseline showed progressive increases in CACS in both treatment arms (P < 0.05 for each time point in both groups). Subjects treated with calcium containing phosphate binders showed more rapid and more severe increases in CACS when compared with those receiving sevelamer hydrochloride (P= 0.056 at 12 months, P= 0.01 at 18 months).


CONCLUSIONS
New hemodialysis patients with no evidence of coronary calcification showed little evidence of disease development over 18 months independent of phosphate binder therapy. However, subjects with evidence of at least mild coronary calcification had significant progression at 6, 12, and 18 months. Use of calcium containing phosphate binders resulted in more rapid progression of coronary calcification than did use of sevelamer hydrochloride.
Block
Geoffrey A
GA
Denver Nephrologists, Denver, Colorado 80218, USA. gablock@denverneph.net
Spiegel
David M
DM
Ehrlich
James
J
Mehta
Ravindra
R
Lindbergh
Jill
J
Dreisbach
Albert
A
Raggi
Paolo
P
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000188:drug therapy* / Q000453:epidemiology; D002118:Calcium / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood; D011073:Polyamines / Q000008:administration & dosage*; D006435:Renal Dialysis; D012307:Risk Factors; D000069603:Sevelamer; D016896:Treatment Outcome
D011073:Polyamines; D010758:Phosphorus; D000069603:Sevelamer; D002118:Calcium