Starting sevelamer may reduce mortality risk among hemodialysis patients treated with calcium-based phosphate binders

People with end-stage renal disease often have abnormally high levels of phosphorus in their blood, which raises their risk of cardiovascular disease and mortality. For many years, the standard treatment to control phosphorus levels was calcium-based phosphate binders, but these have been linked to arterial calcification.

A newer treatment, sevelamer hydrochloride or sevelamer carbonate, is becoming increasingly common as an add-on or alternative therapy to calcium-based phosphate binders. Researchers used data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) to investigate whether starting sevelamer improved survival for hemodialysis patients who had previously been prescribed calcium-based phosphate binders.

They found that after beginning sevelamer therapy, mean serum phosphorus levels decreased by 0.3 mg/dL in the first four months and gradually decreased thereafter. In addition, patients treated with sevelamer had a 14 percent lower risk of mortality compared to as-yet-untreated patients.

“In clinical practice, unlike in randomized trials, sevelamer is used not only as an alternative but also as an adjunct to calcium-based phosphate binder therapy,” said lead author Dr. Hirotaka Komaba. “Our study demonstrates the potential benefit of sevelamer as used in real-world situations and provides an additional rationale for controlling serum phosphorus levels with the use of sevelamer.”

Future studies should focus on determining whether better or more intensive management of high phosphorus levels might reduce mortality risk in hemodialysis patients.

CITATION:Komaba H, Wang M, Taniguchi M, Yamamoto S, Nomura T, Schaubel DE, Smith AR, Zee J, Karaboyas A, Bieber B, Fukagawa M, Tentori F. Initiation of sevelamer and mortality among hemodialysis patients treated with calcium-based phosphate binders. Clin J Am Soc Nephrol. In Press 2017.
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