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Short-term treatment with sevelamer increases serum fetuin-a concentration and improves endothelial dysfunction in chronic kidney disease stage 4 patients.
Clin J Am Soc Nephrol. 2008 Jan; 3(1):61-8.CJ

Abstract

BACKGROUND AND OBJECTIVES

Vascular calcification and endothelial dysfunction contribute to the development of cardiovascular disease in patients with chronic kidney disease (CKD). Sevelamer, a non-calcium-based phosphate binder, has been shown to attenuate cardiovascular calcification in CKD patients, although the exact mechanism has not been clarified. This study was designed to investigate the effect of short-term sevelamer treatment on both serum fetuin-A concentrations and endothelial dysfunction seen in CKD patients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Fifty nondiabetic stage 4 CKD patients whose phosphate levels were > or =5.5 mg/dl were enrolled in this 8-wk randomized prospective study. Thirty-six healthy volunteers served as matched controls. Patients were treated with either sevelamer (n = 25, 12 males) or calcium acetate (n = 25, 13 males). Fetuin-A, high-sensitivity C-reactive protein, Ca x PO4 product, flow-mediated dilation (FMD), insulin, and homeostasis model assessment (HOMA) were obtained at baseline and after the treatment period.

RESULTS

As expected, CKD patients had significantly lower levels of fetuin-A and FMD, and significantly higher levels of intact parathyroid hormone, Ca x PO4 product, and high-sensitivity C-reactive protein than controls (P < 0.001 for all). The use of sevelamer led to a significant increase in the fetuin-A concentration with improvement in FMD, whereas no significant difference was observed in the calcium acetate group. In a multiple regression analysis, FMD levels were independently related to fetuin-A both before (beta = 0.63, P < 0.001) and after (beta = 0.38, P = 0.004) treatment.

CONCLUSIONS

This small, randomized, prospective study shows that short-term sevelamer treatment significantly increases fetuin-A levels and improves FMD in nondiabetic stage 4 CKD patients.

Authors+Show Affiliations

Department of Nephrology, Gülhane School of Medicine, Etlik-Ankara, Turkey.No 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)

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

Language

eng

PubMed ID

18057307

Citation

Caglar, Kayser, et al. "Short-term Treatment With Sevelamer Increases Serum Fetuin-a Concentration and Improves Endothelial Dysfunction in Chronic Kidney Disease Stage 4 Patients." Clinical Journal of the American Society of Nephrology : CJASN, vol. 3, no. 1, 2008, pp. 61-8.
Caglar K, Yilmaz MI, Saglam M, et al. Short-term treatment with sevelamer increases serum fetuin-a concentration and improves endothelial dysfunction in chronic kidney disease stage 4 patients. Clin J Am Soc Nephrol. 2008;3(1):61-8.
Caglar, K., Yilmaz, M. I., Saglam, M., Cakir, E., Acikel, C., Eyileten, T., Yenicesu, M., Oguz, Y., Vural, A., Carrero, J. J., Axelsson, J., Lindholm, B., & Stenvinkel, P. (2008). Short-term treatment with sevelamer increases serum fetuin-a concentration and improves endothelial dysfunction in chronic kidney disease stage 4 patients. Clinical Journal of the American Society of Nephrology : CJASN, 3(1), 61-8.
Caglar K, et al. Short-term Treatment With Sevelamer Increases Serum Fetuin-a Concentration and Improves Endothelial Dysfunction in Chronic Kidney Disease Stage 4 Patients. Clin J Am Soc Nephrol. 2008;3(1):61-8. PubMed PMID: 18057307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short-term treatment with sevelamer increases serum fetuin-a concentration and improves endothelial dysfunction in chronic kidney disease stage 4 patients. AU - Caglar,Kayser, AU - Yilmaz,Mahmut Ilker, AU - Saglam,Mutlu, AU - Cakir,Erdinc, AU - Acikel,Cengizhan, AU - Eyileten,Tayfun, AU - Yenicesu,Mujdat, AU - Oguz,Yusuf, AU - Vural,Abdulgaffar, AU - Carrero,Juan Jesus, AU - Axelsson,Jonas, AU - Lindholm,Bengt, AU - Stenvinkel,Peter, Y1 - 2007/12/05/ PY - 2007/12/7/pubmed PY - 2008/1/31/medline PY - 2007/12/7/entrez SP - 61 EP - 8 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 3 IS - 1 N2 - BACKGROUND AND OBJECTIVES: Vascular calcification and endothelial dysfunction contribute to the development of cardiovascular disease in patients with chronic kidney disease (CKD). Sevelamer, a non-calcium-based phosphate binder, has been shown to attenuate cardiovascular calcification in CKD patients, although the exact mechanism has not been clarified. This study was designed to investigate the effect of short-term sevelamer treatment on both serum fetuin-A concentrations and endothelial dysfunction seen in CKD patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Fifty nondiabetic stage 4 CKD patients whose phosphate levels were > or =5.5 mg/dl were enrolled in this 8-wk randomized prospective study. Thirty-six healthy volunteers served as matched controls. Patients were treated with either sevelamer (n = 25, 12 males) or calcium acetate (n = 25, 13 males). Fetuin-A, high-sensitivity C-reactive protein, Ca x PO4 product, flow-mediated dilation (FMD), insulin, and homeostasis model assessment (HOMA) were obtained at baseline and after the treatment period. RESULTS: As expected, CKD patients had significantly lower levels of fetuin-A and FMD, and significantly higher levels of intact parathyroid hormone, Ca x PO4 product, and high-sensitivity C-reactive protein than controls (P < 0.001 for all). The use of sevelamer led to a significant increase in the fetuin-A concentration with improvement in FMD, whereas no significant difference was observed in the calcium acetate group. In a multiple regression analysis, FMD levels were independently related to fetuin-A both before (beta = 0.63, P < 0.001) and after (beta = 0.38, P = 0.004) treatment. CONCLUSIONS: This small, randomized, prospective study shows that short-term sevelamer treatment significantly increases fetuin-A levels and improves FMD in nondiabetic stage 4 CKD patients. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/18057307/Short_term_treatment_with_sevelamer_increases_serum_fetuin_a_concentration_and_improves_endothelial_dysfunction_in_chronic_kidney_disease_stage_4_patients_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=18057307 DB - PRIME DP - Unbound Medicine ER -