title: Impact of phosphate binder type on coronary artery calcification in hemodialysis patients.
abstract: 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.
authors.affiliation: Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Shantouf
authors.forename: N
authors.initials: N
authors.lastname: Ahmadi
authors.forename: F
authors.initials: F
authors.lastname: Flores
authors.forename: J
authors.initials: J
authors.lastname: Tiano
authors.forename: A
authors.initials: A
authors.lastname: Gopal
authors.forename: K
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.forename: M J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: 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
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; D011073:Polyamines; D000069603:Sevelamer