Sevelamer decreases serum uric acid concentration through adsorption of uric acid in maintenance hemodialysis patients.
BACKGROUND
Sevelamer, a nonabsorbed hydrogel that binds phosphate, is reported to reduce the serum urate concentration in maintenance hemodialysis patients, however the urate-lowering mechanism remains obscure. In this study we verify the urate-lowering effect of sevelamer in Japan in which the hemodialysis environment is different from that of western countries, and we also clarify the urate-lowering mechanism of sevelamer.


METHODS
A total of 127 Japanese patients undergoing maintenance hemodialysis were investigated. These patients consisted of 93 males and 34 females, and their mean age was 58.4+/-12.4 years (range, 25-88 years). The mean duration of hemodialysis was 8.7+/-6.1 years (range, 0.5-27.5 years). Sevelamer was added to each patient's former prescription for the treatment of hyperphosphatemia, and the changes in laboratory data before and after administration of sevelamer were compared. In order to clarify the mechanism of urate-lowering effect by sevelamer, a urate adsorption experiment was carried out in vitro.


RESULTS
Sevelamer significantly decreased serum phosphate value three and six months after administration. Sevelamer showed a significant reduction in serum urate values in maintenance hemodialysis patients with hyperuricemia, but not in patients with normouricemia. The change rate of serum urate correlated with the change rate of serum phosphate and the change rate of serum calcium x phosphate product, but did not correlate with that of serum calcium. Sevelamer hydrochloride adsorbed urate in vitro.


CONCLUSIONS
Sevelamer decreases serum urate possibly by adsorbing urate in hemodialysis patients.
Ohno
Iwao
I
Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo. i-ohno@jikei.ac.jp
Yamaguchi
Yuichiro
Y
Saikawa
Hajime
H
Uetake
Daijiro
D
Hikita
Miho
M
Okabe
Hideaki
H
Ichida
Kimiyoshi
K
Hosoya
Tatsuo
T
D000042:Absorption; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002614:Chelating Agents / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033461:Hyperuricemia / Q000097:blood / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011073:Polyamines / Q000494:pharmacology*; D006435:Renal Dialysis / Q000379:methods*; D000069603:Sevelamer; D013997:Time Factors; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood* / Q000378:metabolism
D002614:Chelating Agents; D011073:Polyamines; D014527:Uric Acid; D000069603:Sevelamer