Impact of phosphate binder type on coronary artery calcification in hemodialysis patients.
OBJECTIVE
In individuals with chronic kidney disease (CKD), including those undergoing maintenance hemodialysis (MHD), coronary artery calcification (CAC) is common. We hypothesized that, in MHD patients, intake of the calcium-free phosphate binder sevelamer is associated with lower CAC compared to calcium-based phosphate binders (CBPB).


METHODS
This is a cross-sectional study of MHD patients, who underwent computerized tomography to assess coronary artery calcium scores (CACS). Patients were stratified into two mutually exclusive groups based on taking only a CBPB vs. sevelamer. Logistic regression was used to calculate adjusted odds ratio (OR) of CACS > or = 400, CACS 100 < or =; CACS < 400, 10 < or =; CACS < 100 vs. CACS < 10.


RESULTS
117 MHD patients were either on a CBPB alone (n = 60) or sevelamer alone (n = 57). Despite increased prevalence of DM in the sevelamer group (58%) as compared to the CBPB group (35%), CACS was significantly lower with sevelamer use (283 + or - 83 vs. 494 + or - 94, p = 0.02). The OR of significant CACS > or =; 400 vs. CAC < 10 was 4.35 (95% confidence interval: 1.5 - 9.9, p = 0.008) for CBPB compared with sevelamer, after controlling for case-mix, cholesterol-lowering medication, DM, and inflammatory markers.


CONCLUSIONS
In our cohort, significant CAC was significantly more prevalent among MHD patients taking CBPB as compared to sevelamer monotherapy.
Shantouf
R
R
Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
Ahmadi
N
N
Flores
F
F
Tiano
J
J
Gopal
A
A
Kalantar-Zadeh
K
K
Budoff
M J
MJ
D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000209:etiology* / Q000517:prevention & control*; D002614:Chelating Agents / Q000627:therapeutic use*; D003327:Coronary Disease / Q000209:etiology* / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011073:Polyamines / Q000627:therapeutic use*; D006435:Renal Dialysis; D000069603:Sevelamer; D016896:Treatment Outcome
D015415:Biomarkers; D002614:Chelating Agents; D011073:Polyamines; D000069603:Sevelamer