Elsevier

Kidney International

Volume 62, Issue 1, July 2002, Pages 245-252
Kidney International

Clinical Nephrology – Epidemiology – Clinical Trials
Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients

https://doi.org/10.1046/j.1523-1755.2002.00434.xGet rights and content
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Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients.

Background

Cardiovascular disease is frequent and severe in patients with end-stage renal disease. Disorders of mineral metabolism may contribute by promoting cardiovascular calcification.

Methods

We conducted a randomized clinical trial comparing sevelamer, a non-absorbed polymer, with calcium-based phosphate binders in 200 hemodialysis patients. Study outcomes included the targeted concentrations of serum phosphorus, calcium, and intact parathyroid hormone (PTH), and calcification of the coronary arteries and thoracic aorta using a calcification score derived from electron beam tomography.

Results

Sevelamer and calcium provided equivalent control of serum phosphorus (end-of-study values 5.1 ± 1.2 and 5.1 ± 1.4 mg/dL, respectively, P = 0.33). Serum calcium concentration was significantly higher in the calcium-treated group (P = 0.002), and hypercalcemia was more common (16% vs. 5% with sevelamer, P = 0.04). More subjects in the calcium group had end-of-study intact PTH below the target of 150 to 300 pg/mL (57% vs. 30%, P = 0.001). At study completion, the median absolute calcium score in the coronary arteries and aorta increased significantly in the calcium treated subjects but not in the sevelamer-treated subjects (coronary arteries 36.6 vs. 0, P = 0.03 and aorta 75.1 vs. 0, P = 0.01, respectively). The median percent change in coronary artery (25% vs. 6%, P = 0.02) and aortic (28% vs. 5%, P = 0.02) calcium score also was significantly greater with calcium than with sevelamer.

Conclusions

Compared with calcium-based phosphate binders, sevelamer is less likely to cause hypercalcemia, low levels of PTH, and progressive coronary and aortic calcification in hemodialysis patients.

Keywords

randomized clinical trial
cardiovascular calcification
end-stage renal disease
mineral metabolism
hypercalcemia

Cited by (0)

1

The Treat to Goal Working Group members include (United States) G.M. Chertow and G. Caputo (San Francisco, CA); P. Raggi (New Orleans, LA); G. Schulman (Nashville, TN); A. Kuhlik, M. Derman and M. Clouse (Boston, MA); J.T. McCarthy and J. Breen (Rochester, MN); J. Silberzweig and J. Markisz (New York, NY); W. Goodman and J. Goldin (Los Angeles, CA); R. Toto and M. Boyce (Dallas, Texas); (Germany) J. Bommer (Heidelberg); H.H. Neumayer, R. Krause, G. Asmus and B. Hamm (Berlin); R. Brunkhors (Hannover); D.H.W. Grönemeyer (Bochum); W. Schulz (Bamberg); J. Braun (Nürnberg); M. Georgi (Mannheim); S. Achenbach and W. Moshage (Erlangen); and (Austria) H. Holzer and R. Rienmüller (Graz).