title: Sevelamer carbonate increases serum bicarbonate in pediatric dialysis patients.
abstract: Sevelamer hydrochloride (HCl), a calcium-free phosphate binder, is increasingly used due to concerns related to calcium exposure and the development of vascular calcifications. However, a common side effect of sevelamer HCl, metabolic acidosis, is particularly concerning in children, as it can contribute to poor growth. Sevelamer carbonate is now available and has been shown to increase serum bicarbonate in adult patients. We conducted a prospective single-center study of pediatric dialysis patients comparing serum bicarbonate before and 3 months after a switch from sevelamer HCl to sevelamer carbonate. Inclusion criteria were a minimum of 3 months of dialysis therapy and either a serum bicarbonate <20 mmol/L or the need for sodium bicarbonate supplementation. Ten hemodialysis and 14 peritoneal dialysis patients, aged 16 +/- 3 years, were enrolled. Whereas serum calcium and phosphorus remained unchanged, serum bicarbonate increased from 20 (17.2-22.0) to 24.5 (20.75-26) mmol/L (p < 0.001) after 3 months of sevelamer carbonate therapy. Sodium bicarbonate supplementation was stopped in all patients (n = 10), reducing the mean daily sodium intake by an average of 2.3 g per patient. These results demonstrate that sevelamer carbonate is an effective phosphate binder that improves acid-base status in pediatric dialysis patients.
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Mattel Children's Hospital at UCLA, Box 951752, Los Angeles, CA 90095-1752, USA. elsagnt@gmail.com
authors.forename: Elsa
authors.initials: E
authors.lastname: Gonzalez
authors.forename: John
authors.initials: J
authors.lastname: Schomberg
authors.forename: Nimisha
authors.initials: N
authors.lastname: Amin
authors.forename: Isidro B
authors.initials: IB
authors.lastname: Salusky
authors.forename: Joshua
authors.initials: J
authors.lastname: Zaritsky
mesh_terms: D000293:Adolescent; D002614:Chelating Agents; D005260:Female; D015312:Hemodialysis Solutions; D006801:Humans; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D011073:Polyamines; D011446:Prospective Studies; D000069603:Sevelamer; D017693:Sodium Bicarbonate / Q000097:blood*
chemical_list: D002614:Chelating Agents; D015312:Hemodialysis Solutions; D011073:Polyamines; D017693:Sodium Bicarbonate; D000069603:Sevelamer