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Department of Nephrology,1 University Hospital; Department of Nephrology,2 General Hospital "G. Hatzikosta" of Ioannina; Biochemistry Laboratory,3 University Hospital of Ioannina, Ioannina, Greece
Correspondence to: K.C. Siamopoulos, Department of Internal Medicine, Medical School, University of Ioannina, GR 451 10 Ioannina, Greece.ksiamop{at}cc.uoi.gr
Background: Dietary phosphorus restriction, oral
administration of phosphorus binders, and dialysis are the main strategies to
control hyperphosphatemia in patients with stage 5 chronic kidney disease.
Aluminum hydroxide (AH) and calcium carbonate, the most commonly used
phosphorus binders, have serious disadvantages, such as aluminum toxicity and
hypercalcemia. Sevelamer hydrochloride (SH) is a relatively new nonabsorbed
calcium- and aluminum-free phosphorus binder. The present study was designed
to evaluate the efficacy of SH in the control of hyperphosphatemia and its
effect, compared to AH, on serum lipid parameters in patients on continuous
ambulatory peritoneal dialysis (CAPD). Methods: 30 stable patients on CAPD were included in an
open-label, randomized crossover study. After a 2-week phosphorus binder
washout period, 15 patients (group I) were administered SH for 8 weeks and in
the remaining patients (group II), AH was introduced (phase A). After a new
2-week washout period, patients crossed over to the alternate agent for
another 8 weeks (phase B). Results: There were similar reductions in serum phosphorus
levels over the course of the study with both agents: by 1.18 ± 0.07
mg/dL (0.38 ± 0.03 mmol/L) with SH and by 1.25 ± 0.15 mg/dL
(0.40 ± 0.05 mmol/L) with AH in phase A (p = NS), and by 1.35
± 0.25 mg/dL (0.43 ± 0.08 mmol/L) with AH and by 1.23 ±
0.80 mg/dL (0.39 ± 0.25 mmol/L) with SH in phase B (p = NS).
Moreover, SH administration was associated with a 10.5% ± 9.4% and a
20.1% ± 6.8% fall in total cholesterol (p < 0.05) and
low-density lipoprotein cholesterol (p < 0.001) in phase A, and
11.9% ± 7.2% (p < 0.05) and 21.5% ± 2.4% (p
< 0.001), respectively, in phase B. In both phases of the study, AH
administration was not followed by a significant change in serum lipid
parameters. Conclusion: Sevelamer hydrochloride is a well-tolerated
alternative to calcium- or aluminum-containing phosphorus binder in the
control of serum phosphorus in CAPD patients. Furthermore, SH improves the
lipid profile in these patients.
KEY WORDS: Sevelamer hydrochloride; phosphorus binders; lipids.
Received 22 May 2005; accepted 3 October 2005.
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