title: Benefits of sevelamer on markers of bone turnover in Taiwanese hemodialysis patients.
abstract: 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.
authors.affiliation: Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Lin
authors.forename: Yung-Ming
authors.initials: YM
authors.lastname: Chen
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
authors.forename: Tzong-Shinn
authors.initials: TS
authors.lastname: Chu
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Kan
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Huang
authors.forename: Shuei-Liong
authors.initials: SL
authors.lastname: Lin
authors.forename: Tze-Wah
authors.initials: TW
authors.lastname: Kao
authors.forename: Jenq-Wen
authors.initials: JW
authors.lastname: Huang
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Chiang
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Yen
authors.forename: Tun-Jun
authors.initials: TJ
authors.lastname: Tsai
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
authors.forename: Ming-Shiou
authors.initials: MS
authors.lastname: Wu
mesh_terms: 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
chemical_list: 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