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Sevelamer and the bone-vascular axis in chronic kidney disease: bone turnover, inflammation, and calcification regulation.
Kidney Int Suppl. 2009 DecKI

Abstract

Hyperphosphatemia is a central characteristic feature of chronic kidney disease-mineral and bone disorder (CKD-MBD). Phosphorus excess is an independent cardiovascular risk factor for morbidity and mortality in patients with advanced CKD. Over the past 40 years, hyperphosphatemia has been a central therapeutic issue in advanced CKD. Mainstays of hyperphosphatemia treatment are reduction of dietary phosphorus, use of phosphate binders, and optimized phosphorus removal via dialysis. Currently, several phosphate binders are approved for use (aluminum, calcium, lanthanum, sevelamer); all share a common functionality in that they bind phosphorus and reduce the amount absorbed in the gastrointestinal lumen. Over the last decade, nephrologists have debated the relative tolerability and efficacy of these agents, especially the potential for vascular calcification and cardiovascular risk reduction. Recent research has focused on the question of whether a metal-free, calcium-free, and non-absorbed binder, such as sevelamer, offers advantages over other binder types. Most notable may be the potential benefit of reducing calcium load. In addition, sevelamer has several additional pleiotropic effects that may extend its basic indication, some of which may help attenuate vascular calcification. These include effects on bone turnover and the link between abnormal vascular processes and bone metabolism (the so-called 'bone-vascular axis'), as well as lipid metabolism, and systemic inflammatory mediators such as fetuin-A. We review the evidence for these pleiotropic effects, and suggest these may help in some way to improve the substantial disease burden in the CKD-MBD population.

Authors+Show Affiliations

Department of Nephrology and Clinical Immunology, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany. Vincent.Brandenburg@post.rwth-aachen.deNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19946324

Citation

Brandenburg, Vincent M., et al. "Sevelamer and the Bone-vascular Axis in Chronic Kidney Disease: Bone Turnover, Inflammation, and Calcification Regulation." Kidney International. Supplement, 2009, pp. S26-33.
Brandenburg VM, Jahnen-Dechent W, Ketteler M. Sevelamer and the bone-vascular axis in chronic kidney disease: bone turnover, inflammation, and calcification regulation. Kidney Int Suppl. 2009.
Brandenburg, V. M., Jahnen-Dechent, W., & Ketteler, M. (2009). Sevelamer and the bone-vascular axis in chronic kidney disease: bone turnover, inflammation, and calcification regulation. Kidney International. Supplement, (114), S26-33. https://doi.org/10.1038/ki.2009.404
Brandenburg VM, Jahnen-Dechent W, Ketteler M. Sevelamer and the Bone-vascular Axis in Chronic Kidney Disease: Bone Turnover, Inflammation, and Calcification Regulation. Kidney Int Suppl. 2009;(114)S26-33. PubMed PMID: 19946324.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sevelamer and the bone-vascular axis in chronic kidney disease: bone turnover, inflammation, and calcification regulation. AU - Brandenburg,Vincent M, AU - Jahnen-Dechent,Willi, AU - Ketteler,Markus, PY - 2009/12/1/entrez PY - 2009/12/1/pubmed PY - 2010/2/26/medline SP - S26 EP - 33 JF - Kidney international. Supplement JO - Kidney Int Suppl IS - 114 N2 - Hyperphosphatemia is a central characteristic feature of chronic kidney disease-mineral and bone disorder (CKD-MBD). Phosphorus excess is an independent cardiovascular risk factor for morbidity and mortality in patients with advanced CKD. Over the past 40 years, hyperphosphatemia has been a central therapeutic issue in advanced CKD. Mainstays of hyperphosphatemia treatment are reduction of dietary phosphorus, use of phosphate binders, and optimized phosphorus removal via dialysis. Currently, several phosphate binders are approved for use (aluminum, calcium, lanthanum, sevelamer); all share a common functionality in that they bind phosphorus and reduce the amount absorbed in the gastrointestinal lumen. Over the last decade, nephrologists have debated the relative tolerability and efficacy of these agents, especially the potential for vascular calcification and cardiovascular risk reduction. Recent research has focused on the question of whether a metal-free, calcium-free, and non-absorbed binder, such as sevelamer, offers advantages over other binder types. Most notable may be the potential benefit of reducing calcium load. In addition, sevelamer has several additional pleiotropic effects that may extend its basic indication, some of which may help attenuate vascular calcification. These include effects on bone turnover and the link between abnormal vascular processes and bone metabolism (the so-called 'bone-vascular axis'), as well as lipid metabolism, and systemic inflammatory mediators such as fetuin-A. We review the evidence for these pleiotropic effects, and suggest these may help in some way to improve the substantial disease burden in the CKD-MBD population. SN - 0098-6577 UR - https://www.unboundmedicine.com/medline/citation/19946324/Sevelamer_and_the_bone_vascular_axis_in_chronic_kidney_disease:_bone_turnover_inflammation_and_calcification_regulation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)53907-0 DB - PRIME DP - Unbound Medicine ER -