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The effects of sevelamer hydrochloride and calcium carbonate on kidney calcification in uremic rats.
J Am Soc Nephrol. 2002 Sep; 13(9):2299-308.JA

Abstract

The control of serum phosphorus (P) and calcium-phosphate (Ca x P) product is critical to the prevention of ectopic calcification in chronic renal failure (CRF). Whereas calcium (Ca) salts, the most commonly used phosphate binders, markedly increase serum Ca and positive Ca balance, the new calcium- and aluminum-free phosphate binder, sevelamer hydrochloride (RenaGel), reduces serum P without altering serum Ca in hemodialysis patients. Using an experimental model of CRF, these studies compare sevelamer and calcium carbonate (CaCO(3)) in the control of serum P, secondary hyperparathyroidism (SH), and ectopic calcifications. 5/6 nephrectomized rats underwent one of the following treatments for 3 mo: uremic + high-P diet (U-HP); UHP + 3% CaCO(3) (U-HP+C); UHP + 3% sevelamer (U-HP+S). Sevelamer treatment controlled serum P independent of increases in serum Ca, thus reducing serum Ca x P product and further deterioration of renal function, as indicated by the highest creatinine clearances. Sevelamer was as effective as CaCO(3) in the control of high-P-induced SH, as shown by similar serum PTH levels, parathyroid (PT) gland weight, and markers of PT hyperplasia. Also, both P binders elicited similar efficacy in reducing the myocardial and hepatic calcifications induced by uremia. However, sevelamer caused a dramatic reduction of renal Ca deposition (29.8 +/- 8.6 micro g/g wet tissue) compared with both U-HP (175.5 +/- 45.7 micro g/g wet tissue, P < 0.01) and the U-HP+C (58.9 +/- 13.7 micro g/g wet tissue, P < 0.04). Histochemical analyses using Von Kossa and Alizarin red S staining of kidney sections confirmed these findings. The high number of foci of calcification in the kidney of uremic controls (108 +/- 25) was reduced to 33.0 +/- 11.3 by CaCO(3) and decreased even further with sevelamer (16.4 +/- 8.9, P < 0.02 versus CaCO(3)). Importantly, the degree of tubulointerstitial fibrosis was also markedly lower in U-HP+S (5%) compared with either U-HP+C (30%) or U-HP (50%). It is concluded that in experimental CRF in rats, despite a similar control of serum P and SH, sevelamer is more effective than CaCO(3) in preventing renal Ca deposition and tubulointerstitial fibrosis, including better preservation of renal function. These findings cannot be extrapolated to human disease, and further studies in patients are necessary to determine the benefits of either P binder.

Authors+Show Affiliations

Renal Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12191974

Citation

Cozzolino, Mario, et al. "The Effects of Sevelamer Hydrochloride and Calcium Carbonate On Kidney Calcification in Uremic Rats." Journal of the American Society of Nephrology : JASN, vol. 13, no. 9, 2002, pp. 2299-308.
Cozzolino M, Dusso AS, Liapis H, et al. The effects of sevelamer hydrochloride and calcium carbonate on kidney calcification in uremic rats. J Am Soc Nephrol. 2002;13(9):2299-308.
Cozzolino, M., Dusso, A. S., Liapis, H., Finch, J., Lu, Y., Burke, S. K., & Slatopolsky, E. (2002). The effects of sevelamer hydrochloride and calcium carbonate on kidney calcification in uremic rats. Journal of the American Society of Nephrology : JASN, 13(9), 2299-308.
Cozzolino M, et al. The Effects of Sevelamer Hydrochloride and Calcium Carbonate On Kidney Calcification in Uremic Rats. J Am Soc Nephrol. 2002;13(9):2299-308. PubMed PMID: 12191974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of sevelamer hydrochloride and calcium carbonate on kidney calcification in uremic rats. AU - Cozzolino,Mario, AU - Dusso,Adriana S, AU - Liapis,Helen, AU - Finch,Jane, AU - Lu,Yan, AU - Burke,Steven K, AU - Slatopolsky,Eduardo, PY - 2002/8/23/pubmed PY - 2003/2/13/medline PY - 2002/8/23/entrez SP - 2299 EP - 308 JF - Journal of the American Society of Nephrology : JASN JO - J Am Soc Nephrol VL - 13 IS - 9 N2 - The control of serum phosphorus (P) and calcium-phosphate (Ca x P) product is critical to the prevention of ectopic calcification in chronic renal failure (CRF). Whereas calcium (Ca) salts, the most commonly used phosphate binders, markedly increase serum Ca and positive Ca balance, the new calcium- and aluminum-free phosphate binder, sevelamer hydrochloride (RenaGel), reduces serum P without altering serum Ca in hemodialysis patients. Using an experimental model of CRF, these studies compare sevelamer and calcium carbonate (CaCO(3)) in the control of serum P, secondary hyperparathyroidism (SH), and ectopic calcifications. 5/6 nephrectomized rats underwent one of the following treatments for 3 mo: uremic + high-P diet (U-HP); UHP + 3% CaCO(3) (U-HP+C); UHP + 3% sevelamer (U-HP+S). Sevelamer treatment controlled serum P independent of increases in serum Ca, thus reducing serum Ca x P product and further deterioration of renal function, as indicated by the highest creatinine clearances. Sevelamer was as effective as CaCO(3) in the control of high-P-induced SH, as shown by similar serum PTH levels, parathyroid (PT) gland weight, and markers of PT hyperplasia. Also, both P binders elicited similar efficacy in reducing the myocardial and hepatic calcifications induced by uremia. However, sevelamer caused a dramatic reduction of renal Ca deposition (29.8 +/- 8.6 micro g/g wet tissue) compared with both U-HP (175.5 +/- 45.7 micro g/g wet tissue, P < 0.01) and the U-HP+C (58.9 +/- 13.7 micro g/g wet tissue, P < 0.04). Histochemical analyses using Von Kossa and Alizarin red S staining of kidney sections confirmed these findings. The high number of foci of calcification in the kidney of uremic controls (108 +/- 25) was reduced to 33.0 +/- 11.3 by CaCO(3) and decreased even further with sevelamer (16.4 +/- 8.9, P < 0.02 versus CaCO(3)). Importantly, the degree of tubulointerstitial fibrosis was also markedly lower in U-HP+S (5%) compared with either U-HP+C (30%) or U-HP (50%). It is concluded that in experimental CRF in rats, despite a similar control of serum P and SH, sevelamer is more effective than CaCO(3) in preventing renal Ca deposition and tubulointerstitial fibrosis, including better preservation of renal function. These findings cannot be extrapolated to human disease, and further studies in patients are necessary to determine the benefits of either P binder. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/12191974/The_effects_of_sevelamer_hydrochloride_and_calcium_carbonate_on_kidney_calcification_in_uremic_rats_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=12191974 DB - PRIME DP - Unbound Medicine ER -