title: Phosphate binder impact on bone remodeling and coronary calcification--results from the BRiC study.
abstract: 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.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Daniela Veit
authors.initials: DV
authors.lastname: Barreto
authors.forename: Fellype de Carvalho
authors.initials: Fde C
authors.lastname: Barreto
authors.forename: Aluízio Barbosa
authors.initials: AB
authors.lastname: de Carvalho
authors.forename: Lilian
authors.initials: L
authors.lastname: Cuppari
authors.forename: Sérgio Antonio
authors.initials: SA
authors.lastname: Draibe
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Dalboni
authors.forename: Rosa Maria Affonso
authors.initials: RM
authors.lastname: Moyses
authors.forename: Kátia Rodrigues
authors.initials: KR
authors.lastname: Neves
authors.forename: Vanda
authors.initials: V
authors.lastname: Jorgetti
authors.forename: Marcio
authors.initials: M
authors.lastname: Miname
authors.forename: Raul D
authors.initials: RD
authors.lastname: Santos
authors.forename: Maria Eugênia Fernandes
authors.initials: ME
authors.lastname: Canziani
mesh_terms: 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
chemical_list: D000085:Acetates; D017610:Calcium Compounds; D002614:Chelating Agents; D011073:Polyamines; D000069603:Sevelamer; C120662:calcium acetate