Benefits of sevelamer on markers of bone turnover in Taiwanese hemodialysis patients.
OBJECTIVE
Sevelamer hydrochloride is a recently developed phosphate binder, which is a quaternary amine anion exchanger without calcium or aluminum. Sevelamer is effective in controlling hyperphosphatemia without increasing the calcium load in chronic hemodialysis (HD) patients. We investigated whether sevelamer restored bone metabolism in chronic HD patients.


METHODS
An 8-week, prospective, open-label, randomized study was conducted after a 2-week washout period in chronic hyperphosphatemic HD patients. This study compared the effect of sevelamer on markers of bone turnover with that of calcium acetate, as stratified by baseline serum intact parathyroid hormone (iPTH) level.


RESULTS
There was no difference in the changes of serum phosphorus, calcium-phosphorus product and serum iPTH between the sevelamer and the calcium acetate groups. However, more hypercalcemic events (12%) were documented under calcium acetate treatment. In patients with hypoparathyroidism, calcium acetate treatment decreased serum iPTH at the end of the study, while sevelamer did not. Increased serum alkaline phosphatase levels were found among patients receiving sevelamer treatment compared with those who received calcium acetate treatment. In those patients receiving sevelamer, the serum alkaline phosphatase level was also positively correlated to the sevelamer dosage (r = 0.246, p = 0.013).


CONCLUSIONS
Sevelamer effectively reduces serum phosphorus with a lower incidence of hypercalcemic effects in HD patients. Sevelamer is an effective means of treatment for chronic hyperphosphatemic HD patients, especially those with hypoparathyroidism.
Lin
Yu-Feng
YF
Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Chen
Yung-Ming
YM
Hung
Kuan-Yu
KY
Chu
Tzong-Shinn
TS
Kan
Wei-Chih
WC
Huang
Chih-Yuan
CY
Lin
Shuei-Liong
SL
Kao
Tze-Wah
TW
Huang
Jenq-Wen
JW
Chiang
Wen-Chih
WC
Yen
Chung-Jen
CJ
Tsai
Tun-Jun
TJ
Wu
Kwan-Dun
KD
Wu
Ming-Shiou
MS
D000085:Acetates / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood / Q000187:drug effects; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D016723:Bone Remodeling / Q000187:drug effects*; D017610:Calcium Compounds / Q000008:administration & dosage; D002130:Calcium Phosphates / Q000378:metabolism; D002614:Chelating Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000139:chemically induced; D054559:Hyperphosphatemia / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D010760:Phosphorus Metabolism Disorders / Q000097:blood / Q000209:etiology; D011073:Polyamines / Q000008:administration & dosage*; D011446:Prospective Studies; D006435:Renal Dialysis; D000069603:Sevelamer; D016896:Treatment Outcome
D000085:Acetates; D015415:Biomarkers; D017610:Calcium Compounds; D002130:Calcium Phosphates; D002614:Chelating Agents; D010281:Parathyroid Hormone; D011073:Polyamines; D010758:Phosphorus; D000069603:Sevelamer; D000469:Alkaline Phosphatase; C120662:calcium acetate