title: Comparison of efficacy of the phosphate binders nicotinic acid and sevelamer hydrochloride in hemodialysis patients.
abstract: Hyperphosphatemia is a significant risk factor for the development of ectopic calcification and coronary artery diseases in patients on hemodialysis (HD), and must be controlled with the use of phosphate binders. Studies comparing the effects of sevelamer and nicotinic acid, both similar non-calcium and non-aluminum phosphate binders, are not available. In this study, 40 patients on HD with a serum phosphorus level of more than 6 mg/dL were enrolled. After a two week washout period without phosphate binders, the patients were randomly divided into two equal groups (n = 20) and were started on nicotinic acid or sevelamer for a period of four weeks. The dose of nicotinic acid used was 500 mg and that of sevelamer was 1600 mg daily. Blood samples were drawn for the measurement of the total calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), triglyceride (TG), total cholesterol (Chol), high-density lipoprotein (HDL), low-density lipoprotein (LDL), uric acid and parathyroid hormone (PTH). Patients receiving sevelamer showed a significant reduction in serum P level (2.2 ± 0.69 mg/dL; P <0.0001) in comparison with the nicotinic acid group (1.7 ± 1.06 mg/dL; P = 0.004). Reduction in the Ca-P product was significantly different in the two groups; in the sevelamer group, it was 21 ± 7; (P <0.0001) while in the nicotinic acid group, it was 16 ± 11 (P = 0.007). Also, patients on sevelamer showed greater reduction in the mean TG level (38.9 ± 92 mg/dL; P = 0.005). No significant changes were observed in the mean serum Ca, total Chol, HDL, LDL, ALP and iPTH levels in the two study groups. Our short-term study suggests that although nicotinic acid reduced hyperphosphatemia, sevelamer showed higher efficacy in controlling hyperphosphatemia as well as the Ca-P product.
authors.affiliation: Department of Nephrology Research Center, Tehran University of Medical Science, Imam Khomeni Hospital, Iran. f_ahmadish@yahoo.com
authors.forename: Farrokhlagha
authors.initials: F
authors.lastname: Ahmadi
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Shamekhi
authors.forename: Mahbob
authors.initials: M
authors.lastname: Lessan-Pezeshki
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Khatami
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D002614:Chelating Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007492:Iran; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000628:therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood*; D011073:Polyamines / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects*; D000069603:Sevelamer; D013997:Time Factors; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; D008055:Lipids; C470125:PTH protein, human; D010281:Parathyroid Hormone; D011073:Polyamines; D009525:Niacin; D014527:Uric Acid; D010758:Phosphorus; D000069603:Sevelamer; D000469:Alkaline Phosphatase; D002118:Calcium