Effect of sevelamer hydrochloride on markers of bone turnover in Japanese dialysis patients with low biointact PTH levels.
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.
Iwata
Yasunori
Y
Disease Control and Homeostasis, Kanazawa University Graduate School of Medicine. iwata-knz@umin.ac.jp
Wada
Takashi
T
Yokoyama
Hitoshi
H
Toyama
Tadashi
T
Kitajima
Shinji
S
Okumura
Toshiya
T
Hara
Akinori
A
Yamahana
Junya
J
Nakaya
Izaya
I
Kobayashi
Motoo
M
Kitagawa
Kiyoki
K
Kokubo
Satoshi
S
Yoshimoto
Keiichi
K
Shimizu
Kazuaki
K
Sakai
Norihiko
N
Furuichi
Kengo
K
Koshino
Yoshitaka
Y
Takeda
Shinichi
S
Takasawa
Kazuya
K
Ohta
Satoshi
S
Takaeda
Masayoshi
M
Takaeda
Chikako
C
Kaneko
Shuichi
S
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
D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone; D011073:Polyamines; D000069603:Sevelamer; D002118:Calcium