title: Serological cardiovascular and mortality risk predictors in dialysis patients receiving sevelamer: a prospective study.
abstract: BACKGROUND
  Cardiovascular morbidity and mortality are massively increased in patients with chronic kidney disease (CKD). Sevelamer hydrochloride has been shown to attenuate cardiovascular calcifications in CKD and end-stage renal disease (ESRD) patients. We assessed how sevelamer hydrochloride influences the evolution of serum fetuin-A and other serological factors predicting cardiovascular outcome and survival in haemodialysis patients.
  
  
  METHODS
  Fifty-seven prevalent haemodialysis patients were included in a three-phase prospective interventional trial (A-B-A design; 8 weeks per phase). Sevelamer was only administered in the middle phase of the study. Within the other two phases, >or=90% of the patients received calcium acetate for phosphate binding. Detailed time courses of serum biochemistries were analysed in order to obtain detailed insight into the influence of sevelamer upon CKD-mineral and bone disorder (MBD) parameters as well as serum fetuin-A, fibroblast growth factor 23 (FGF23) and uraemic toxin levels [uric acid, indoxyl sulphate, hippuric acid, indole acetic acid, p-cresol and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF)].
  
  
  RESULTS
  Forty-one patients finished the three prospective study phases (intention-to-treat analysis). After treatment with sevelamer, serum fetuin-A significantly increased (+21%), showing a delayed increase outlasting the third (non-sevelamer) study period. Total and low-density lipoprotein (LDL) cholesterol levels, as well as serum calcium, decreased significantly. The opposite occurred with albumin, C-reactive protein and intact parathyroid hormone (iPTH). FGF23, uric acid, indoxyl sulphate, hippuric acid, indole acetic acid, CMPF and serum phosphate did not change significantly during sevelamer treatment. In contrast, in parallel to sevelamer treatment, there was a significant rise in serum P-cresol.
  
  
  CONCLUSIONS
  In haemodialysis patients, treatment with sevelamer over 8 weeks was associated with a delayed yet long-lasting increase in serum fetuin-A levels. Increasing the serum level of fetuin-A, a negative acute-phase protein and systemic calcification inhibitor, might be one of the potential anti-calcification mechanisms of sevelamer. Since we failed to detect a decrease in systemic inflammation and uraemic toxins, the exact mechanisms by which sevelamer treatment affects serum fetuin-A remain to be determined.
authors.affiliation: Department of Nephrology, University Hospital of the RWTH Aachen, Pauwelsstase 30, Aachen, Germany. vincent.brandenburg@post.rwth-aachen.de
authors.forename: Vincent Matthias
authors.initials: VM
authors.lastname: Brandenburg
authors.forename: Georg
authors.initials: G
authors.lastname: Schlieper
authors.forename: Nicole
authors.initials: N
authors.lastname: Heussen
authors.forename: Stefan
authors.initials: S
authors.lastname: Holzmann
authors.forename: Birgit
authors.initials: B
authors.lastname: Busch
authors.forename: Pieter
authors.initials: P
authors.lastname: Evenepoel
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.forename: Björn
authors.initials: B
authors.lastname: Meijers
authors.forename: Natalie
authors.initials: N
authors.lastname: Meert
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Fassbender
authors.forename: Jürgen
authors.initials: J
authors.lastname: Floege
authors.forename: Willi
authors.initials: W
authors.lastname: Jahnen-Dechent
authors.forename: Markus
authors.initials: M
authors.lastname: Ketteler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality* / Q000517:prevention & control; D002614:Chelating Agents / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood; D002908:Chronic Disease; D005260:Female; D000089703:Fibroblast Growth Factor-23; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011073:Polyamines / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D000069603:Sevelamer; D015996:Survival Rate; D055815:Young Adult; D060749:alpha-2-HS-Glycoprotein
chemical_list: C556354:AHSG protein, human; D001798:Blood Proteins; D002614:Chelating Agents; D008078:Cholesterol, LDL; C000717427:FGF23 protein, human; D011073:Polyamines; D060749:alpha-2-HS-Glycoprotein; D000089703:Fibroblast Growth Factor-23; D002097:C-Reactive Protein; D000069603:Sevelamer; D002118:Calcium