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Clinical Trial
. 2002 Jul;62(1):245-52.
doi: 10.1046/j.1523-1755.2002.00434.x.

Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients

Glenn M Chertow  1 , Steven K Burke, Paolo Raggi; Treat to Goal Working Group
Affiliations
Free article
Clinical Trial

Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients

Glenn M Chertow et al. Kidney Int. 2002 Jul.
Free article

Abstract

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.

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Comment in

  • Calcium on trial: beyond a reasonable doubt?
    Canavese C, Bergamo D, Dib H, Bermond F, Burdese M. Canavese C, et al. Kidney Int. 2003 Jan;63(1):381-2; author reply 383-4. doi: 10.1046/j.1523-1755.2003.00746.x. Kidney Int. 2003. PMID: 12472809 No abstract available.
  • Calcium on trial: beyond a reasonable doubt?
    Fournier A, Benyahia M, Claudia CP, Sadek T. Fournier A, et al. Kidney Int. 2003 Jan;63(1):382-3; author reply 383-4. doi: 10.1046/j.1523-1755.2003.t01-1-00746.x. Kidney Int. 2003. PMID: 12472810 No abstract available.
  • Calcium on trial: beyond a reasonable doubt?
    Cleveland M. Cleveland M. Kidney Int. 2003 Jan;63(1):383; author reply 383-4. doi: 10.1046/j.1523-1755.2003.t01-2-00746.x. Kidney Int. 2003. PMID: 12472811 No abstract available.
  • Calcium on trial: beyond a reasonable doubt?
    Nolan CR, Quinibi WY. Nolan CR, et al. Kidney Int. 2003 Jan;63(1):383; author reply 383-4. doi: 10.1046/j.1523-1755.2003.t01-3-00746.x. Kidney Int. 2003. PMID: 12472812 No abstract available.
  • Dialysate calcium use in hemodialysis patients.
    Backenroth R. Backenroth R. Kidney Int. 2003 Oct;64(4):1533. doi: 10.1046/j.1523-1755.2003.00247.x. Kidney Int. 2003. PMID: 12969180 No abstract available.
  • Renal disease medications and evidence-biased medicine.
    Goudas PC. Goudas PC. Kidney Int. 2003 Oct;64(4):1533-4. doi: 10.1046/j.1523-1755.2003.00248.x. Kidney Int. 2003. PMID: 12969181 No abstract available.
  • Sevelamer: where are the data?
    McCarron DA. McCarron DA. Kidney Int. 2003 Dec;64(6):2329; author reply 2329-30. doi: 10.1046/j.1523-1755.2003.341_10.x. Kidney Int. 2003. PMID: 14633168 No abstract available.

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