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The role of sevelamer in achieving the kidney disease outcomes quality initiative (K/DOQI) guidelines for hyperphosphatemia.
Curr Med Res Opin. 2004 Jul; 20(7):991-9.CM

Abstract

BACKGROUND

End-stage renal disease (ESRD) is a chronic health care problem associated with multiple co-morbidities and escalating costs. Disregulation of mineral metabolism (principally hyperphosphatemia and hypercalcemia) contributes to substantial morbidity and mortality. Accordingly, new and more-aggressive Kidney Disease Outcomes Quality Initiative (K/DOQI) Guidelines from the National Kidney Foundation promote lower serum phosphorus (3.5-5.5 mg/dL), lower calcium (8.4-9.5 mg/dL), and lower calcium-phosphorus product (< 55 mg(2)/dL(2)) targets.

REVIEW FINDINGS

Traditional calcium-based and metal-based phosphate binders are effective but are associated with side effects and toxicity that limit their use. Achieving rigorous K/DOQI goals demands higher therapeutic doses of phosphate binders and may require more-aggressive use of calcium-free and metal-free phosphate binders. Sevelamer hydrochloride is a calcium- and metal-free polymer that binds phosphate effectively without contributing to calcium load or metal accumulation. In the Treat-to-Goal trial, sevelamer-treated dialysis patients had less progression of coronary and aortic calcification than patients treated with calcium-based binders. This offers the potential promise of reducing cardiovascular morbidity and mortality. The 800-mg tablet (Renagel) increases the daily sevelamer dose while reducing the number of tablets required per meal. Nine of the 800-mg tablets per day (3 x 800-mg tablets tid with meals) of sevelamer monotherapy have been shown to achieve K/DOQI serum phosphorus and calcium-phosphorus product targets.

CONCLUSION

In summary, this review of the current evidence-base concludes that the new, more-aggressive, K/DOQI goals limit the use of metal-based and calcium-based phosphate binders. Sevelamer offers the advantages of lowering serum phosphorus without the risks of calcium or metal accumulation - and offers the promise of slowing the progression of vascular calcification and potentially reducing the morbidity and mortality of hemodialysis patients.

Authors+Show Affiliations

Pharmacy and Nephrology, College of Pharmacy, University of New Mexico, Albequerque, 87131, USA. abpai@salus.unm.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

15265243

Citation

Pai, A B., et al. "The Role of Sevelamer in Achieving the Kidney Disease Outcomes Quality Initiative (K/DOQI) Guidelines for Hyperphosphatemia." Current Medical Research and Opinion, vol. 20, no. 7, 2004, pp. 991-9.
Pai AB, Smeeding JE, Brook RA. The role of sevelamer in achieving the kidney disease outcomes quality initiative (K/DOQI) guidelines for hyperphosphatemia. Curr Med Res Opin. 2004;20(7):991-9.
Pai, A. B., Smeeding, J. E., & Brook, R. A. (2004). The role of sevelamer in achieving the kidney disease outcomes quality initiative (K/DOQI) guidelines for hyperphosphatemia. Current Medical Research and Opinion, 20(7), 991-9.
Pai AB, Smeeding JE, Brook RA. The Role of Sevelamer in Achieving the Kidney Disease Outcomes Quality Initiative (K/DOQI) Guidelines for Hyperphosphatemia. Curr Med Res Opin. 2004;20(7):991-9. PubMed PMID: 15265243.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of sevelamer in achieving the kidney disease outcomes quality initiative (K/DOQI) guidelines for hyperphosphatemia. AU - Pai,A B, AU - Smeeding,J E, AU - Brook,R A, PY - 2004/7/22/pubmed PY - 2004/12/16/medline PY - 2004/7/22/entrez SP - 991 EP - 9 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 20 IS - 7 N2 - BACKGROUND: End-stage renal disease (ESRD) is a chronic health care problem associated with multiple co-morbidities and escalating costs. Disregulation of mineral metabolism (principally hyperphosphatemia and hypercalcemia) contributes to substantial morbidity and mortality. Accordingly, new and more-aggressive Kidney Disease Outcomes Quality Initiative (K/DOQI) Guidelines from the National Kidney Foundation promote lower serum phosphorus (3.5-5.5 mg/dL), lower calcium (8.4-9.5 mg/dL), and lower calcium-phosphorus product (< 55 mg(2)/dL(2)) targets. REVIEW FINDINGS: Traditional calcium-based and metal-based phosphate binders are effective but are associated with side effects and toxicity that limit their use. Achieving rigorous K/DOQI goals demands higher therapeutic doses of phosphate binders and may require more-aggressive use of calcium-free and metal-free phosphate binders. Sevelamer hydrochloride is a calcium- and metal-free polymer that binds phosphate effectively without contributing to calcium load or metal accumulation. In the Treat-to-Goal trial, sevelamer-treated dialysis patients had less progression of coronary and aortic calcification than patients treated with calcium-based binders. This offers the potential promise of reducing cardiovascular morbidity and mortality. The 800-mg tablet (Renagel) increases the daily sevelamer dose while reducing the number of tablets required per meal. Nine of the 800-mg tablets per day (3 x 800-mg tablets tid with meals) of sevelamer monotherapy have been shown to achieve K/DOQI serum phosphorus and calcium-phosphorus product targets. CONCLUSION: In summary, this review of the current evidence-base concludes that the new, more-aggressive, K/DOQI goals limit the use of metal-based and calcium-based phosphate binders. Sevelamer offers the advantages of lowering serum phosphorus without the risks of calcium or metal accumulation - and offers the promise of slowing the progression of vascular calcification and potentially reducing the morbidity and mortality of hemodialysis patients. SN - 0300-7995 UR - https://www.unboundmedicine.com/medline/citation/15265243/The_role_of_sevelamer_in_achieving_the_kidney_disease_outcomes_quality_initiative__K/DOQI__guidelines_for_hyperphosphatemia_ L2 - https://www.tandfonline.com/doi/full/10.1185/030079904125004015 DB - PRIME DP - Unbound Medicine ER -