title: Effects of sevelamer hydrochloride on mortality, lipid abnormality and arterial stiffness in hemodialyzed patients: a propensity-matched observational study.
abstract: BACKGROUND
  Cause-and-effect associations between sevelamer hydrochloride (HCl) and mortality have yet to be clarified. The effects of sevelamer HCl on mortality, lipid abnormality and arterial stiffness were examined in patients with chronic kidney disease stage 5D.
  
  
  METHODS
  The effects of sevelamer HCl were studied by a single-center cohort study that was conducted from January 1, 2005 to December 31, 2008 (n = 483). By the end of the study, 172 patients (Sevelamer group) had succeeded in continuing sevelamer HCl for >6 months (median 37 months), and 300 patients (Control group) had received calcium carbonate (n = 264) or no phosphate binder (n = 36). The mortality and other outcomes were compared between these two groups after matching by a propensity score calculated using age, gender, diabetes prevalence, and dialysis vintage.
  
  
  RESULTS
  All-cause [hazard ratio (HR) 0.4, P = 0.02] and cardiovascular (CV)-cause [HR 0.29, P = 0.03] cumulative mortality were significantly lower in the matched Sevelamer group than in the matched Control group. The matched Sevelamer group showed increased high-density lipoprotein cholesterol (P = 0.003) and no change in pulse wave velocity (PWV) and ankle-brachial index (ABI), whereas the matched Control group showed increased serum low-density lipoprotein (LDL) cholesterol (P = 0.003), increased PWV (P = 0.03), and decreased ABI (P = 0.0009). Change in serum LDL cholesterol level correlated inversely with sevelamer HCl dosage (P = 0.02).
  
  
  CONCLUSIONS
  Reduced mortality in patients with sevelamer HCl may, at least in part, be explained by an improvement in dyslipidemia and arterial stiffness by sevelamer HCl.
authors.affiliation: Department of Nephrology, Shuwa General Hospital, Saitama, Japan. siimori.kid@tmd.ac.jp
authors.forename: Soichiro
authors.initials: S
authors.lastname: Iimori
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mori
authors.forename: Wataru
authors.initials: W
authors.lastname: Akita
authors.forename: Shigeru
authors.initials: S
authors.lastname: Takada
authors.forename: Tamaki
authors.initials: T
authors.lastname: Kuyama
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ohnishi
authors.forename: Satomi
authors.initials: S
authors.lastname: Shikuma
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishigami
authors.forename: Masato
authors.initials: M
authors.lastname: Tajima
authors.forename: Tomoki
authors.initials: T
authors.lastname: Asai
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Okado
authors.forename: Michio
authors.initials: M
authors.lastname: Kuwahara
authors.forename: Sei
authors.initials: S
authors.lastname: Sasaki
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsukamoto
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D002119:Calcium Carbonate / Q000494:pharmacology; D002614:Chelating Agents / Q000494:pharmacology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D050356:Lipid Metabolism / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011073:Polyamines / Q000494:pharmacology*; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D000069603:Sevelamer; D012720:Severity of Illness Index; D015996:Survival Rate; D059289:Vascular Stiffness / Q000187:drug effects* / Q000502:physiology
chemical_list: D002614:Chelating Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D011073:Polyamines; D000069603:Sevelamer; D002119:Calcium Carbonate