Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients.
Elevated serum phosphorus and calcium are associated with arterial calcification and mortality in dialysis patients. Unlike calcium-based binders, sevelamer attenuates arterial calcification but it is unknown whether sevelamer affects mortality or morbidity. In a multicenter, randomized, open-label, parallel design trial we compared sevelamer and calcium-based binders on all-cause and cause-specific mortality (cardiovascular, infection, and other) in prevalent hemodialysis patients. A total of 2103 patients were initially randomized to treatment and 1068 patients completed the study. All-cause mortality rates and cause-specific mortality rates were not significantly different. There was a significant age interaction on the treatment effect. Only in patients over 65 years of age was there a significant effect of sevelamer in lowering the mortality rate. There was a suggestion that sevelamer was associated with lower overall, but not cardiovascular-linked, mortality in older patients. We suggest that further research is needed to confirm these findings.
Suki
W N
WN
Renal Section, Department of Medicine, The Kidney Institute, Baylor College of Medicine, Houston, Texas 77054, USA. wsuki@bcm.tmc.edu
Zabaneh
R
R
Cangiano
J L
JL
Reed
J
J
Fischer
D
D
Garrett
L
L
Ling
B N
BN
Chasan-Taber
S
S
Dillon
M A
MA
Blair
A T
AT
Burke
S K
SK
D000085:Acetates / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D002118:Calcium / Q000097:blood; D002119:Calcium Carbonate / Q000009:adverse effects / Q000627:therapeutic use*; D017610:Calcium Compounds / Q000009:adverse effects / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D002614:Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood; D011073:Polyamines / Q000009:adverse effects / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000401:mortality*; D000069603:Sevelamer; D016896:Treatment Outcome
D000085:Acetates; D017610:Calcium Compounds; D002614:Chelating Agents; D011073:Polyamines; D010758:Phosphorus; D000069603:Sevelamer; D002119:Calcium Carbonate; D002118:Calcium; C120662:calcium acetate