Phosphate binder impact on bone remodeling and coronary calcification--results from the BRiC study.
OBJECTIVE
Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients. This is a prospective study that compares the effects of calcium acetate and sevelamer on coronary calcification (CAC) and bone histology.


METHODS
101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice coronary tomographies and bone biopsies at entry and 12 months.


RESULTS
The 71 patients who concluded the study had similar baseline characteristics. On follow-up, the sevelamer group had higher levels of intact parathyroid hormone (498 +/- 352 vs. 326 +/- 236 pg/ml, p = 0.017), bone alkaline phosphatase (38 +/- 24 vs. 28 +/- 15 U/l, p = 0.03) and deoxypyridinoline (135 +/- 107 vs. 89 +/- 71 nmol/l, p = 0.03) and lower LDL cholesterol (74 +/- 21 vs. 91 +/- 28 mg/dl, p = 0.015). Phosphorus (5.8 +/- 1.0 vs. 6 +/- 1.0 mg/dl, p = 0.47) and calcium (1.27 +/- 0.07 vs. 1.23 +/- 0.08 mmol/l, p = 0.68) levels did not differ between groups. CAC progression (35 vs. 24%, p = 0.94) and bone histological diagnosis at baseline and 12 months were similar in both groups. Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption (eroded surface, ES/BS = 9.0 +/- 5.9 vs. 13.1 +/- 9.5%, p = 0.05), whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate (BFR/BS = 0.015 +/- 0.016 vs. 0.062 +/- 0.078, p = 0.003 for calcium and 0.017 +/- 0.016 vs. 0.071 +/- 0.084 microm(3)/microm(2)/day, p = 0.010 for sevelamer).


CONCLUSIONS
There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups.
Barreto
Daniela Veit
DV
Division of Nephrology, Department of Internal Medicine, Federal University of São Paulo, São Paulo, Brazil.
Barreto
Fellype de Carvalho
Fde C
de Carvalho
Aluízio Barbosa
AB
Cuppari
Lilian
L
Draibe
Sérgio Antonio
SA
Dalboni
Maria Aparecida
MA
Moyses
Rosa Maria Affonso
RM
Neves
Kátia Rodrigues
KR
Jorgetti
Vanda
V
Miname
Marcio
M
Santos
Raul D
RD
Canziani
Maria Eugênia Fernandes
ME
D000085:Acetates / Q000008:administration & dosage*; D016723:Bone Remodeling / Q000187:drug effects*; D001938:Brazil / Q000453:epidemiology; D002114:Calcinosis / Q000453:epidemiology*; D017610:Calcium Compounds / Q000008:administration & dosage; D002614:Chelating Agents / Q000008:administration & dosage; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011073:Polyamines / Q000008:administration & dosage*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D000069603:Sevelamer; D016896:Treatment Outcome
D000085:Acetates; D017610:Calcium Compounds; D002614:Chelating Agents; D011073:Polyamines; D000069603:Sevelamer; C120662:calcium acetate