The Effects of Sevelamer and Calcium Acetate on Proxies of Atherosclerotic and Arteriosclerotic Vascular Disease in Hemodialysis Patients

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background: We recently determined that in hemodialysis patients, the use of calcium salts to correct hyperphosphatemia led to progressive coronary artery and aortic calcification as determined by sequential electron beam tomography (EBT) while the use of the non-calcium-containing binder sevelamer did not. Whether the specific calcium preparation (acetate vs. carbonate) might influence the likelihood of progressive calcification was debated. Methods: To determine whether treatment with calcium acetate was specifically associated with hypercalcemia and progressive vascular calcification, we conducted an analysis restricted to 108 hemodialysis patients randomized to calcium acetate or sevelamer and followed for one year. Results: The reduction in serum phosphorus was roughly equivalent with both agents (calcium acetate –2.5 ± 1.8 mg/dl vs. sevelamer –2.8 ± 2.0 mg/dl, p = 0.53). Subjects given calcium acetate were more likely to develop hypercalcemia (defined as an albumin-corrected serum calcium ≧10.5 mg/dl) (36 vs. 13%, p = 0.015). Treatment with calcium acetate (mean 4.6 ± 2.1 g/day – equivalent to 1.2 ± 0.5 g of elemental calcium) led to a significant increase in EBT-determined calcification of the coronary arteries (mean change 182 ± 350, median change +20, p = 0.002) and aorta (mean change 181 ± 855, median change +73, p < 0.0001). These changes were similar in magnitude to those seen with calcium carbonate. There were no significant changes in calcification among sevelamer-treated subjects. Conclusion: Despite purported differences in safety and efficacy relative to calcium carbonate, calcium acetate led to hypercalcemia and progressive vascular calcification in hemodialysis patients.

Related collections

Author and article information

Journal

Journal ID (publisher-id): AJN

Journal ID (nlm-ta): Am J Nephrol

Journal ID (doi): 10.1159/issn.0250-8095

Title: American Journal of Nephrology

Publisher: S. Karger AG

ISSN (Print): 0250-8095

ISSN (Electronic): 1421-9670

Publication date Subscription-year: 2003

Publication date (Print): October 2003

Publication date (Electronic): 08 September 2003

Volume: 23

Issue: 5

Pages: 307-314

Affiliations

^aDivisions of Nephrology, Moffitt-Long Hospitals and UCSF-Mt. Zion Medical Center, Department of Medicine, University of California San Francisco, San Francisco, Calif., ^bDivision of Cardiology, Department of Medicine, Tulane University, New Orleans, La., ^cDivision of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minn., ^dDivision of Nephrology, Department of Medicine, Vanderbilt University, Nashville, Tenn., ^eThe Rogosin Institute and Division of Nephrology, Department of Medicine, Cornell University, New York, N.Y., ^fDivision of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass., ^gDivision of Nephrology, Department of Medicine, University of California Los Angeles, Los Angeles, Calif., ^hGelTex Pharmaceuticals, Inc., Waltham, Mass., and ⁱDivision of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Tex., USA

Article

Publisher ID: 72822 Other ID: Am J Nephrol 2003;23:307–314

DOI: 10.1159/000072822

PubMed ID: 12915774

SO-VID: 6eed1b63-dd4d-4070-875b-460f6b935f81

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date accepted : 27 June 2003

Page count

Figures: 1, Tables: 3, References: 40, Pages: 8

Comments

Comment on this article

scite_

Cited by 12

See all cited by

- Version 1
- Version 1

Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

Submit here before December 31, 2024