title: Long-term management of sevelamer hydrochloride-induced metabolic acidosis aggravation and hyperkalemia in hemodialysis patients.
abstract: Sevelamer hydrochloride use in hemodialysis patients is complicated by metabolic acidosis aggravation and hyperkalemia. Rare reports about a short-term correction of this complication have been published. The current authors investigated the long-term correction of metabolic acidosis and hyperkalemia in sevelamer hydrochloride-treated patients at doses adequate to achieve serum phosphate levels within K/DOQI recommendations. The authors followed 20 hemodialysis patients for 24 months in an open-label prospective study. The dialysate bicarbonate concentration was increased stepwise to a maximum 40 mEq/L and adjusted to reach patient serum bicarbonate levels of 22 mEq/L, according to K/DOQI recommendations. Laboratory results for serum bicarbonate, potassium, calcium, phosphate, albumin, alkaline phosphatase, iPTH, cholesterol (HDL-LDL), triglycerides, Kt/V, systolic-diastolic arterial pressure were recorded. Sevelamer hydrochloride-induced metabolic acidosis aggravation and hyperkalemia in hemodialysis patients were corrected, on the long-term, by an increase in dialysate bicarbonate concentration. Further improvement in bone biochemistry was noted with this adequate acidosis correction and parallel sevelamer hydrochloride administration, in sufficiently large doses to achieve K/DOQI phosphate recommendations.
authors.affiliation: Nephrology Department, A. Fleming General Hospital, Athens, Greece.
authors.forename: Macroui
authors.initials: M
authors.lastname: Sonikian
authors.forename: Polyxeni
authors.initials: P
authors.lastname: Metaxaki
authors.forename: Anastasios
authors.initials: A
authors.lastname: Iliopoulos
authors.forename: Stamatia
authors.initials: S
authors.lastname: Marioli
authors.forename: Dimosthenis
authors.initials: D
authors.lastname: Vlassopoulos
mesh_terms: D000138:Acidosis / Q000097:blood / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001639:Bicarbonates / Q000032:analysis* / Q000097:blood; D002118:Calcium / Q000097:blood; D015314:Dialysis Solutions / Q000032:analysis*; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood / Q000378:metabolism*; D011073:Polyamines / Q000009:adverse effects*; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis; D000069603:Sevelamer
chemical_list: D001639:Bicarbonates; D015314:Dialysis Solutions; D010281:Parathyroid Hormone; D010710:Phosphates; D011073:Polyamines; D000069603:Sevelamer; D011188:Potassium; D002118:Calcium