Effects of sevelamer and calcium-based phosphate binders on lipid and inflammatory markers in hemodialysis patients.
BACKGROUND
Cardiovascular disease accounts for almost half of all deaths in individuals with chronic kidney disease stage 5 despite advances in both dialysis treatment and cardiology. A combination of lipid-lowering and anti-inflammatory effects along with avoidance of hypercalcemia should be taken into account when choosing phosphorus binders for maintenance hemodialysis (MHD) patients.


METHODS
We examined the association of sevelamer versus calcium-based phosphorus binders with lipid profile, inflammatory markers including C-reactive protein (CRP), and mineral metabolism in MHD patients who participated in the Nutritional and Inflammatory Evaluation of Dialysis Patients (NIED) study from October 2001 to July 2005.


RESULTS
Of the 787 MHD patients in the NIED study, 697 were on either sevelamer, a calcium-based binder, or both and eligible for this study. We compared the groups based on taking sevelamer monotherapy (n = 283) or calcium binder monotherapy (n = 266) for serum phosphate control. There were no differences between the groups on dialysis vintage. There were significant differences in age, serum calcium and phosphorus levels, as well as intact parathyroid hormone levels. Using a logistic regression models, the sevelamer group had a higher odds of serum CRP <10 mg/l [odds ratio (OR): 1.06, 95% CI: 1.02-1.11] and LDL cholesterol <70 mg/dl (OR: 1.33, 95% CI: 1.19-1.47) when compared to the calcium binder group independent of age, vintage, body mass index, statin use or other variables.


CONCLUSIONS
The improvements in multiple surrogate markers of inflammation and lipids in the NIED study make sevelamer a promising therapy for treatment in MHD patients with high risk of cardiovascular disease and mortality.
Shantouf
Ronney
R
Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, Calif. 90502, USA.
Budoff
Matthew J
MJ
Ahmadi
Naser
N
Tiano
Jima
J
Flores
Ferdinand
F
Kalantar-Zadeh
Kamyar
K
D000367:Age Factors; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000627:therapeutic use*; D002614:Chelating Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D008055:Lipids / Q000737:chemistry*; D008297:Male; D008875:Middle Aged; D011073:Polyamines / Q000627:therapeutic use*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000097:blood* / Q000628:therapy*; D000069603:Sevelamer; D016896:Treatment Outcome
D002614:Chelating Agents; D008055:Lipids; D011073:Polyamines; D002097:C-Reactive Protein; D000069603:Sevelamer; D002118:Calcium