Effect of sevelamer hydrochloride exposure on carotid intima media thickness in hemodialysis patients.
BACKGROUND
Elevated phosphorus (P) and calcium (Ca)-P product (Ca × P) are associated with vascular calcification and cardiovascular disease (CVD) morbidity and CVD and all-cause mortality.


OBJECTIVE
This study examined the effect of sevelamer hydrochloride exposure (regardless of calcium carbonate exposure) on carotid and femoral intima media thickness (IMT), reliable surrogate measures of prospective intimal thickening, in end-stage renal disease patients on maintenance hemodialysis.


METHODS
The present cross-sectional study is nested in the Sevelamer hydrochloride and ultrasound-measured femoral and carotid intima media thickness progression in end-stage renal disease (SUMMER) clinical trial. Carotid and femoral arteries were visualized in B-mode ultrasonography. Log-transformed IMT was compared by sevelamer hydrochloride exposure and modeled using multiple linear regression.


RESULTS
Forty-five subjects were exposed to sevelamer hydrochloride and 130 were not. Exposed subjects had significantly lower carotid IMT, an association which persisted in the multiple linear regression model even after controlling for potentially confounding variables including serum Ca, history of CVD and body weight. Exposed subjects had lower low-density lipoprotein cholesterol levels and significantly higher parathyroid hormone, but no differences in P, Ca and Ca × P.


CONCLUSIONS
Sevelamer hydrochloride was associated with lower carotid IMT. This association may be mediated through reduction in Ca load, low-density lipoprotein cholesterol lowering or some other pleiotropic effect.
Boaz
M
M
Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel.
Katzir
Z
Z
Schwartz
D
D
Gafter
U
U
Biro
A
A
Shtendik
L
L
Kon
V
V
Chernin
G
G
Weinstein
T
T
D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000187:drug effects*; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000209:etiology* / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications / Q000534:rehabilitation; D008297:Male; D009929:Organ Size / Q000187:drug effects; D011073:Polyamines / Q000009:adverse effects* / Q000627:therapeutic use; D006435:Renal Dialysis / Q000009:adverse effects*; D000069603:Sevelamer; D016896:Treatment Outcome; D017539:Tunica Intima / Q000000981:diagnostic imaging* / Q000187:drug effects*; D014463:Ultrasonography
D011073:Polyamines; D000069603:Sevelamer