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Protein-Bound Uremic Toxins Lowering Effect of Sevelamer in Pre-Dialysis Chronic Kidney Disease Patients with Hyperphosphatemia: A Randomized Controlled Trial.
Toxins (Basel). 2021 09 27; 13(10)T

Abstract

P-cresyl sulfate and indoxyl sulfate are strongly associated with cardiovascular events and all-cause mortality in chronic kidney disease (CKD). This randomized controlled trial was conducted to compare the effects between sevelamer and calcium carbonate on protein-bound uremic toxins in pre-dialysis CKD patients with hyperphosphatemia. Forty pre-dialysis CKD patients with persistent hyperphosphatemia were randomly assigned to receive either 2400 mg of sevelamer daily or 1500 mg of calcium carbonate daily for 24 weeks. A significant decrease of total serum p-cresyl sulfate was observed in sevelamer therapy compared to calcium carbonate therapy (mean difference between two groups -5.61 mg/L; 95% CI -11.01 to -0.27 mg/L; p = 0.04). There was no significant difference in serum indoxyl sulfate levels (p = 0.36). Sevelamer had effects in terms of lowering fibroblast growth factor 23 (p = 0.01) and low-density lipoprotein cholesterol levels (p = 0.04). Sevelamer showed benefits in terms of retarding CKD progression. Changes in vascular stiffness were not found in this study.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand.Clinical Pharmacokinetics and Pharmacogenomics Research Unit, Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.Clinical Pharmacokinetics and Pharmacogenomics Research Unit, Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.Division of Cardiology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand. Department of Microbiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand. Translational Research in Inflammation and Immunology Research Unit (TRIRU), Department of Microbiology, Chulalongkorn University, Bangkok 10330, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand. Research Unit for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.

Pub Type(s)

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

Language

eng

PubMed ID

34678981

Citation

Takkavatakarn, Kullaya, et al. "Protein-Bound Uremic Toxins Lowering Effect of Sevelamer in Pre-Dialysis Chronic Kidney Disease Patients With Hyperphosphatemia: a Randomized Controlled Trial." Toxins, vol. 13, no. 10, 2021.
Takkavatakarn K, Puapatanakul P, Phannajit J, et al. Protein-Bound Uremic Toxins Lowering Effect of Sevelamer in Pre-Dialysis Chronic Kidney Disease Patients with Hyperphosphatemia: A Randomized Controlled Trial. Toxins (Basel). 2021;13(10).
Takkavatakarn, K., Puapatanakul, P., Phannajit, J., Sukkumme, W., Chariyavilaskul, P., Sitticharoenchai, P., Leelahavanichkul, A., Katavetin, P., Praditpornsilpa, K., Eiam-Ong, S., & Susantitaphong, P. (2021). Protein-Bound Uremic Toxins Lowering Effect of Sevelamer in Pre-Dialysis Chronic Kidney Disease Patients with Hyperphosphatemia: A Randomized Controlled Trial. Toxins, 13(10). https://doi.org/10.3390/toxins13100688
Takkavatakarn K, et al. Protein-Bound Uremic Toxins Lowering Effect of Sevelamer in Pre-Dialysis Chronic Kidney Disease Patients With Hyperphosphatemia: a Randomized Controlled Trial. Toxins (Basel). 2021 09 27;13(10) PubMed PMID: 34678981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Protein-Bound Uremic Toxins Lowering Effect of Sevelamer in Pre-Dialysis Chronic Kidney Disease Patients with Hyperphosphatemia: A Randomized Controlled Trial. AU - Takkavatakarn,Kullaya, AU - Puapatanakul,Pongpratch, AU - Phannajit,Jeerath, AU - Sukkumme,Warumphon, AU - Chariyavilaskul,Pajaree, AU - Sitticharoenchai,Patita, AU - Leelahavanichkul,Asada, AU - Katavetin,Pisut, AU - Praditpornsilpa,Kearkiat, AU - Eiam-Ong,Somchai, AU - Susantitaphong,Paweena, Y1 - 2021/09/27/ PY - 2021/09/01/received PY - 2021/09/20/revised PY - 2021/09/21/accepted PY - 2021/10/22/entrez PY - 2021/10/23/pubmed PY - 2022/2/16/medline KW - chronic kidney disease KW - indoxyl sulfate KW - p-cresyl sulfate KW - protein-bound uremic toxins KW - sevelamer JF - Toxins JO - Toxins (Basel) VL - 13 IS - 10 N2 - P-cresyl sulfate and indoxyl sulfate are strongly associated with cardiovascular events and all-cause mortality in chronic kidney disease (CKD). This randomized controlled trial was conducted to compare the effects between sevelamer and calcium carbonate on protein-bound uremic toxins in pre-dialysis CKD patients with hyperphosphatemia. Forty pre-dialysis CKD patients with persistent hyperphosphatemia were randomly assigned to receive either 2400 mg of sevelamer daily or 1500 mg of calcium carbonate daily for 24 weeks. A significant decrease of total serum p-cresyl sulfate was observed in sevelamer therapy compared to calcium carbonate therapy (mean difference between two groups -5.61 mg/L; 95% CI -11.01 to -0.27 mg/L; p = 0.04). There was no significant difference in serum indoxyl sulfate levels (p = 0.36). Sevelamer had effects in terms of lowering fibroblast growth factor 23 (p = 0.01) and low-density lipoprotein cholesterol levels (p = 0.04). Sevelamer showed benefits in terms of retarding CKD progression. Changes in vascular stiffness were not found in this study. SN - 2072-6651 UR - https://www.unboundmedicine.com/medline/citation/34678981/Protein_Bound_Uremic_Toxins_Lowering_Effect_of_Sevelamer_in_Pre_Dialysis_Chronic_Kidney_Disease_Patients_with_Hyperphosphatemia:_A_Randomized_Controlled_Trial_ L2 - https://www.mdpi.com/resolver?pii=toxins13100688 DB - PRIME DP - Unbound Medicine ER -