title: A comparison of sevelamer hydrochloride with calcium acetate on biomarkers of bone turnover in hemodialysis patients.
abstract: OBJECTIVE
  To evaluate the influence of sevelamer hydrochloride and calcium acetate on biomarkers of bone turnover in patients with hyperphosphatemia receiving hemodialysis.
  
  
  METHODS
  In this prospective, open-label, randomized, active-controlled study, 70 patients (38 men and 32 women) with hyperphosphatemia (serum phosphorus level >6.0 mg/dL) underwent a two-week washout period and were randomly selected to receive sevelamer hydrochloride (n = 37) or calcium acetate (n = 33) for eight weeks. Changes in serum levels of intact parathyroid hormone (iPTH), alkaline phosphatase (Alk-P), phosphorus, and calcium were measured and compared.
  
  
  RESULTS
  After eight weeks of treatment, calcium acetate lowered iPTH levels significantly more than sevelamer hydrochloride did (-178.0 vs. -69.0 pg/mL, p = 0.0019). Levels of Alk-P were significantly elevated in patients given sevelamer hydrochloride compared with levels in those given calcium acetate treatment (24.09 vs. 7.45 U/L, p = 0.0014). Changes in serum phosphorus levels did not differ between sevelamer hydrochloride (-1.93 mg/dL) and calcium acetate (-2.5 mg/dL) at the end of the study (p = 0.0514). Changes in the calcium and phosphorous product did not significantly differ between the sevelamer-hydrochloride group (-18.06 mg2/dL2) and the calcium-acetate group (-19.05 mg2/dL2, p = 0.6764). Fifteen patients (45.5%) treated with calcium acetate had hypercalcemia (serum-adjusted calcium level >10.5 mg/dL); the rate was significantly higher than that of patients treated with sevelamer (five [13.5%] of 37, p = 0.0039).
  
  
  CONCLUSIONS
  Treatment with sevelamer hydrochloride had the advantage of maintaining stable iPTH levels and elevating Alk-P levels while lowering serum phosphorus levels and calcium-phosphorous product.
authors.affiliation: Division of Nephrology, Department of Medicine, China Medical University Hospital, No. 2 Yu-der Road, North District, Taichung City 404, Taiwan.
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Liu
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Lin
authors.forename: Chun-Chen
authors.initials: CC
authors.lastname: Yu
authors.forename: Huey-Liang
authors.initials: HL
authors.lastname: Kuo
authors.forename: Ya-Fei
authors.initials: YF
authors.lastname: Yang
authors.forename: Che-Yi
authors.initials: CY
authors.lastname: Chou
authors.forename: Po-Wen
authors.initials: PW
authors.lastname: Lin
authors.forename: Jiung-Hsiun
authors.initials: JH
authors.lastname: Liu
authors.forename: Pen-Yuan
authors.initials: PY
authors.lastname: Liao
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D000085:Acetates / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood / Q000187:drug effects; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D016723:Bone Remodeling / Q000187:drug effects*; D002118:Calcium / Q000097:blood; D017610:Calcium Compounds / Q000008:administration & dosage / Q000009:adverse effects; D002614:Chelating Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000139:chemically induced; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D010760:Phosphorus Metabolism Disorders / Q000097:blood / Q000209:etiology; D011073:Polyamines / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D006435:Renal Dialysis; D012107:Research Design; D000069603:Sevelamer; D016896:Treatment Outcome
chemical_list: D000085:Acetates; D015415:Biomarkers; D017610:Calcium Compounds; D002614:Chelating Agents; D010281:Parathyroid Hormone; D011073:Polyamines; D010758:Phosphorus; D000069603:Sevelamer; D000469:Alkaline Phosphatase; D002118:Calcium; C120662:calcium acetate