Tags

Type your tag names separated by a space and hit enter

Sevelamer worsens metabolic acidosis in hemodialysis patients.
J Nephrol. 2006 Mar-Apr; 19 Suppl 9:S108-14.JN

Abstract

BACKGROUND

Sevelamer hydrochloride, a major phosphate binder for patients on maintenance hemodialysis (MHD) is associated with reduced serum bicarbonate concentration due to hydrochloric acid release in the gut and to the binding of short chain fatty acids in the large intestine. Since metabolic acidosis can be deleterious, a study was devised to compare the time course of serum bicarbonate concentration during treatment with sevelamer hydrochloride or calcium carbonate.

METHODS

Sixteen well nourished patients on MHD who were in excellent clinical conditions and achieving target levels for blood pressure (BP) and hemoglobin (Hb), while on a protein intake of 1.1g/kg body weight (bw), were enrolled in the study. After a 2-week washout period, the patients were divided into two groups, each consisting of eight patients, and randomized either to 24 weeks of sevelamer followed by 24 weeks of calcium carbonate (group A) or to 24 weeks of calcium carbonate followed by 24 weeks of sevelamer (group B). Protein intake, n-protein catabolic rate (nPCR), serum concentrations of calcium, phosphate, calcium x phosphate (Ca x P) product, bicarbonate, intact parathyroid hormone (iPTH) and albumin were monitored. Time course changes in serum bicarbonate concentrations in relation to short and long dialytic intervals (48 vs. 72 hr) were also investigated.

RESULTS

Both sevelamer and calcium carbonate effectively controlled serum phosphate and the Ca x P product. During calcium carbonate treatment plasma phosphate concentrations were significantly below those of patients on sevelamer. Plasma bicarbonate concentration fell within target DOQI values during calcium carbonate administration both in group A and in group B, a goal which was not achieved under sevelamer administration. After a long dialytic interval in patients on sevelamer, serum bicarbonate concentration averaged 17.3 +/- 1.1 mEq/L, whereas it averaged 21.1 +/- 0.7 mEq/L in patients on calcium carbonate (p<0.01). Finally, a 24-week sevelamer administration caused a statistically significant (p<0.05) reduction (0.8 g/dL) in serum albumin concentration, without affecting iPTH. Taken together, these results indicate that sevelamer worsens metabolic acidosis, which needs to be corrected.

Authors+Show Affiliations

First Division of Nephrology, Second University of Naples, Naples, Italy. nataleg.desanto@unina2.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

16736432

Citation

De Santo, N G., et al. "Sevelamer Worsens Metabolic Acidosis in Hemodialysis Patients." Journal of Nephrology, vol. 19 Suppl 9, 2006, pp. S108-14.
De Santo NG, Frangiosa A, Anastasio P, et al. Sevelamer worsens metabolic acidosis in hemodialysis patients. J Nephrol. 2006;19 Suppl 9:S108-14.
De Santo, N. G., Frangiosa, A., Anastasio, P., Marino, A., Correale, G., Perna, A., Di Stazio, E., Stellato, D., Santoro, D., Di Meglio, E., Iacono, G., Ciacci, C., Savica, V., & Cirillo, M. (2006). Sevelamer worsens metabolic acidosis in hemodialysis patients. Journal of Nephrology, 19 Suppl 9, S108-14.
De Santo NG, et al. Sevelamer Worsens Metabolic Acidosis in Hemodialysis Patients. J Nephrol. 2006 Mar-Apr;19 Suppl 9:S108-14. PubMed PMID: 16736432.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sevelamer worsens metabolic acidosis in hemodialysis patients. AU - De Santo,N G, AU - Frangiosa,A, AU - Anastasio,P, AU - Marino,A, AU - Correale,G, AU - Perna,A, AU - Di Stazio,E, AU - Stellato,D, AU - Santoro,D, AU - Di Meglio,E, AU - Iacono,G, AU - Ciacci,C, AU - Savica,V, AU - Cirillo,M, PY - 2006/6/1/pubmed PY - 2006/8/17/medline PY - 2006/6/1/entrez SP - S108 EP - 14 JF - Journal of nephrology JO - J Nephrol VL - 19 Suppl 9 N2 - BACKGROUND: Sevelamer hydrochloride, a major phosphate binder for patients on maintenance hemodialysis (MHD) is associated with reduced serum bicarbonate concentration due to hydrochloric acid release in the gut and to the binding of short chain fatty acids in the large intestine. Since metabolic acidosis can be deleterious, a study was devised to compare the time course of serum bicarbonate concentration during treatment with sevelamer hydrochloride or calcium carbonate. METHODS: Sixteen well nourished patients on MHD who were in excellent clinical conditions and achieving target levels for blood pressure (BP) and hemoglobin (Hb), while on a protein intake of 1.1g/kg body weight (bw), were enrolled in the study. After a 2-week washout period, the patients were divided into two groups, each consisting of eight patients, and randomized either to 24 weeks of sevelamer followed by 24 weeks of calcium carbonate (group A) or to 24 weeks of calcium carbonate followed by 24 weeks of sevelamer (group B). Protein intake, n-protein catabolic rate (nPCR), serum concentrations of calcium, phosphate, calcium x phosphate (Ca x P) product, bicarbonate, intact parathyroid hormone (iPTH) and albumin were monitored. Time course changes in serum bicarbonate concentrations in relation to short and long dialytic intervals (48 vs. 72 hr) were also investigated. RESULTS: Both sevelamer and calcium carbonate effectively controlled serum phosphate and the Ca x P product. During calcium carbonate treatment plasma phosphate concentrations were significantly below those of patients on sevelamer. Plasma bicarbonate concentration fell within target DOQI values during calcium carbonate administration both in group A and in group B, a goal which was not achieved under sevelamer administration. After a long dialytic interval in patients on sevelamer, serum bicarbonate concentration averaged 17.3 +/- 1.1 mEq/L, whereas it averaged 21.1 +/- 0.7 mEq/L in patients on calcium carbonate (p<0.01). Finally, a 24-week sevelamer administration caused a statistically significant (p<0.05) reduction (0.8 g/dL) in serum albumin concentration, without affecting iPTH. Taken together, these results indicate that sevelamer worsens metabolic acidosis, which needs to be corrected. SN - 1121-8428 UR - https://www.unboundmedicine.com/medline/citation/16736432/Sevelamer_worsens_metabolic_acidosis_in_hemodialysis_patients_ DB - PRIME DP - Unbound Medicine ER -