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Ten-year experience with sevelamer and calcium salts as phosphate binders.
Clin J Am Soc Nephrol. 2010 Jan; 5 Suppl 1:S31-40.CJ

Abstract

Most patients with chronic kidney disease experience abnormalities in serum calcium, phosphorus, parathyroid hormone, and vitamin D metabolism. These can lead to vascular calcification (VC), which has been associated with increased risk for cardiovascular disease and mortality. Although hyperphosphatemia is believed to be a risk factor for mortality and VC, no randomized trial was ever designed to demonstrate that lowering phosphate reduces mortality. Nonetheless, binders have been used extensively, and the preponderance of evidence shows that sevelamer slows the development of VC whereas calcium salts do not. Four studies have demonstrated a slower progression of VC with sevelamer than with calcium-containing binders, although a fifth study showed nonsuperiority. Conversely, the results on mortality with sevelamer have been variable, and data on calcium-based binders are nonexistent. Improved survival with sevelamer was demonstrated in a small randomized clinical trial, whereas a larger randomized trial failed to show a benefit. In addition, preclinical models of renal failure and preliminary clinical data on hemodialysis patients suggest a potential benefit for bone with sevelamer. Meanwhile, several randomized and observational studies suggested no improvement in bone density and fracture rate, and a few noted an increase in total and cardiovascular mortality in the general population given calcium supplements. Although additional studies are needed, there are at least indications that sevelamer may improve vascular and bone health and, perhaps, mortality in hemodialysis patients, whereas data on calcium-based binders are lacking.

Authors+Show Affiliations

Department of Medicine and Radiology, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA 30322, USA. praggi@emory.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20089501

Citation

Raggi, Paolo, et al. "Ten-year Experience With Sevelamer and Calcium Salts as Phosphate Binders." Clinical Journal of the American Society of Nephrology : CJASN, vol. 5 Suppl 1, 2010, pp. S31-40.
Raggi P, Vukicevic S, Moysés RM, et al. Ten-year experience with sevelamer and calcium salts as phosphate binders. Clin J Am Soc Nephrol. 2010;5 Suppl 1:S31-40.
Raggi, P., Vukicevic, S., Moysés, R. M., Wesseling, K., & Spiegel, D. M. (2010). Ten-year experience with sevelamer and calcium salts as phosphate binders. Clinical Journal of the American Society of Nephrology : CJASN, 5 Suppl 1, S31-40. https://doi.org/10.2215/CJN.05880809
Raggi P, et al. Ten-year Experience With Sevelamer and Calcium Salts as Phosphate Binders. Clin J Am Soc Nephrol. 2010;5 Suppl 1:S31-40. PubMed PMID: 20089501.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ten-year experience with sevelamer and calcium salts as phosphate binders. AU - Raggi,Paolo, AU - Vukicevic,Slobodan, AU - Moysés,Rosa Maria, AU - Wesseling,Katherine, AU - Spiegel,David M, PY - 2010/1/22/entrez PY - 2010/2/3/pubmed PY - 2010/4/3/medline SP - S31 EP - 40 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 5 Suppl 1 N2 - Most patients with chronic kidney disease experience abnormalities in serum calcium, phosphorus, parathyroid hormone, and vitamin D metabolism. These can lead to vascular calcification (VC), which has been associated with increased risk for cardiovascular disease and mortality. Although hyperphosphatemia is believed to be a risk factor for mortality and VC, no randomized trial was ever designed to demonstrate that lowering phosphate reduces mortality. Nonetheless, binders have been used extensively, and the preponderance of evidence shows that sevelamer slows the development of VC whereas calcium salts do not. Four studies have demonstrated a slower progression of VC with sevelamer than with calcium-containing binders, although a fifth study showed nonsuperiority. Conversely, the results on mortality with sevelamer have been variable, and data on calcium-based binders are nonexistent. Improved survival with sevelamer was demonstrated in a small randomized clinical trial, whereas a larger randomized trial failed to show a benefit. In addition, preclinical models of renal failure and preliminary clinical data on hemodialysis patients suggest a potential benefit for bone with sevelamer. Meanwhile, several randomized and observational studies suggested no improvement in bone density and fracture rate, and a few noted an increase in total and cardiovascular mortality in the general population given calcium supplements. Although additional studies are needed, there are at least indications that sevelamer may improve vascular and bone health and, perhaps, mortality in hemodialysis patients, whereas data on calcium-based binders are lacking. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/20089501/Ten_year_experience_with_sevelamer_and_calcium_salts_as_phosphate_binders_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=20089501 DB - PRIME DP - Unbound Medicine ER -