title: Effect of sevelamer hydrochloride on markers of bone turnover in Japanese dialysis patients with low biointact PTH levels.
abstract: BACKGROUND
  In hemodialysis patients, adynamic bone disease has been reported to be closely associated with low levels of parathyroid hormone (PTH) due to exposure to high levels of serum calcium following the administration of calcium carbonate (CaCO3) or vitamin D agents. This study was conducted to clarify the therapeutic effect of a non-calcemic phosphate binder, sevelamer hydrochloride (sevelamer), for hypoparathyroidism in hemodialysis patients with or without diabetes mellitus.
  
  
  METHODS
  Based on entry criteria, 40 Japanese chronic hemodialysis patients (22 males and 18 females with a mean age of 60.6, 14 diabetic patients and 26 non-diabetic patients) were switched from CaCO3 to sevelamer for 48 weeks. Serum calcium, phosphate, intact (i) PTH and PTH-(1-84) were analyzed. Bone remodeling activity was evaluated by determining intact osteocalcine (iOC), bone-specific alkaline phosphatase (BAP).
  
  
  RESULTS
  The switch from CaCO3 to sevelamer significantly decreased the serum levels of calcium, resulting in the elevation of iPTH levels from 31+/-18 pg/mL to 95+/-96 pg/mL by 48 weeks. In contrast, serum phosphate levels remained similar to those in patients with CaCO3 treatment. Concomitantly, the levels of BAP and iOC were elevated. Further, these beneficial effects on bone turnover were observed in both diabetic and non-diabetic patients.
  
  
  CONCLUSIONS
  Sevelamer reduced the calcium concentration and thereby increased PTH levels, resulting in the improvement of markers of bone turnover. The administration of sevelamer is of therapeutic benefit for the improvement of bone remodeling activity even in hemodialysis patients with diabetes.
authors: Disease Control and Homeostasis, Kanazawa University Graduate School of Medicine. iwata-knz@umin.ac.jp
authors: Yasunori
authors: Y
authors: Iwata
authors: Takashi
authors: T
authors: Wada
authors: Hitoshi
authors: H
authors: Yokoyama
authors: Tadashi
authors: T
authors: Toyama
authors: Shinji
authors: S
authors: Kitajima
authors: Toshiya
authors: T
authors: Okumura
authors: Akinori
authors: A
authors: Hara
authors: Junya
authors: J
authors: Yamahana
authors: Izaya
authors: I
authors: Nakaya
authors: Motoo
authors: M
authors: Kobayashi
authors: Kiyoki
authors: K
authors: Kitagawa
authors: Satoshi
authors: S
authors: Kokubo
authors: Keiichi
authors: K
authors: Yoshimoto
authors: Kazuaki
authors: K
authors: Shimizu
authors: Norihiko
authors: N
authors: Sakai
authors: Kengo
authors: K
authors: Furuichi
authors: Yoshitaka
authors: Y
authors: Koshino
authors: Shinichi
authors: S
authors: Takeda
authors: Kazuya
authors: K
authors: Takasawa
authors: Satoshi
authors: S
authors: Ohta
authors: Masayoshi
authors: M
authors: Takaeda
authors: Chikako
authors: C
authors: Takaeda
authors: Shuichi
authors: S
authors: Kaneko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D016723:Bone Remodeling / Q000187:drug effects* / Q000502:physiology; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011073:Polyamines / Q000494:pharmacology*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D000069603:Sevelamer
chemical_list: D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone; D011073:Polyamines; D000069603:Sevelamer; D002118:Calcium