Epicardial adipose tissue volume increase in hemodialysis patients treated with sevelamer or calcium-based phosphate binders: a substudy of the Renagel in new dialysis trial.
BACKGROUND
In the general population and in hemodialysis patients epicardial adipose tissue (EAT) has been associated with increased mortality and cardiovascular events. Weight loss and lipid lowering therapies reduced EAT in the general population. It is unknown whether sevelamer, a phosphate (Pi) binder that lowers cholesterol and reduces inflammation in dialysis patients also affects EAT progression.


METHODS
Post-hoc analysis of a randomized trial of sevelamer (SVL) versus calcium-based Pi binders (CPiB) in incident hemodialysis patients. EAT was measured on cardiac computed tomography scans performed at enrollment, 6, 12 and 18 months from baseline.


RESULTS
Of 109 patients, 54 received SVL and 55 CPiB; the median LDL change was -16.4 % (IQR: -67.5, 142.3 %) and 12.1 % (IQR: -51.9, 193.8 %) with SVL and CPiB respectively (p < 0.001). At baseline EAT correlated significantly with gender, body mass index and total coronary artery calcium score (all p < 0.02). At the end of follow-up, EAT progressed significantly from baseline in the CPiB treated patients but not in the SVL treated patients [median increase 9.1 % (p = 0.005) vs 3.9 % (p = 0.25)]. However, there was no significant difference in the degree of progression between treatment groups (p = 0.34). There was no correlation between LDL or CRP change and EAT change. There were insufficient events in either arm to assess the impact of EAT change on mortality.


CONCLUSIONS
EAT progression from baseline was significantly smaller with SVL than with CPiB, although the difference between treatments was not statistically significant, probably due to the small sample size. Change in serum lipids and markers of inflammation did not predict EAT progression.
Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
Sung Min
SM
Ko
Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
Chao
C
Zhang
Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
Zhengjia
Z
Chen
Hospital Residència Sant Camil, Ronda Sant Camil, 08810, Sant Pere de Ribes, Catalunya, Spain.|Clínica Puerto Ordaz, Unidad Avanzada de Investigación y Diagnostico Ecográfico y Renal, Puerto Ordaz, 8050, Venezuela.
Luis
L
D'Marco
Sant' Anna Hospital, Como, Italy.|University of Milan, Milan, Italy.
Antonio
A
Bellasi
Division of Cardiothoracic Imaging, Department of Radiology, Emory University, Atlanta, GA, USA.
Arthur E
AE
Stillman
Denver Nephrology, Denver, CO, USA.
Geoffrey
G
Block
Division of Cardiothoracic Imaging, Department of Radiology, Emory University, Atlanta, GA, USA. raggi@ualberta.ca.|Mazankowski Alberta Heart Institute, University of Alberta School of Medicine, 8440-112 Street, Suite 4A7.050, Edmonton, AB, T6G2B7, Canada. raggi@ualberta.ca.
Paolo
P
Raggi
D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D050154:Adiposity / Q000187:drug effects*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D017610:Calcium Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D002614:Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D010710:Phosphates / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects; D000069603:Sevelamer / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D015415:Biomarkers; D017610:Calcium Compounds; D002614:Chelating Agents; D010710:Phosphates; D000069603:Sevelamer
Epicardial adipose tissue; Hemodialysis; Phosphate binders