Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis

• Published in: Kidney international Vol. 68; no. 4; pp. 1815 - 1824
• Main Authors: Block, Geoffrey A., Spiegel, David M., Ehrlich, James, Mehta, Ravindra, Lindbergh, Jill, Dreisbach, Albert, Raggi, Paolo
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2005; Nature Publishing; Elsevier Limited
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Calcinosis - drug therapy; Calcinosis - epidemiology; Calcium - administration & dosage; Coronary Artery Disease - drug therapy; Coronary Artery Disease - epidemiology; Emergency and intensive care: renal failure. Dialysis management; Female; Humans; incident hemodialysis patients; Intensive care medicine; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; phosphate binders; Phosphorus - blood; Polyamines - administration & dosage; randomized controlled trial; Renal Dialysis; Risk Factors; Sevelamer; Treatment Outcome; vascular calcification; phosphate binders; incident hemodialysis patients; vascular calcification; randomized controlled trial; Human; Phosphates; Nephrology; Calcium; Hemodialysis; Coronary artery; Binders; Inorganic element; Urology; Extrarenal dialysis; Blood vessel; Randomised controlled trial; Chelating agent; Calcification; Circulatory system; Sevelamer
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1111/j.1523-1755.2005.00600.x

Effects of sevelamer and calcium on coronary artery calcification in patients to new hemodialysis. Hemodialysis patients are at increased risk for progressive coronary artery calcification; however, the development and progression of this disease process in patients new to hemodialysis is unknown. One hundred and twenty-nine patients new to hemodialysis were randomized to receive calcium containing phosphate binders or the noncalcium phosphate binder sevelamer hydrochloride. Subjects underwent electron beam computed tomography scanning (EBCT) at entry into the study and again at 6, 12, and 18 months. One hundred and nine patients underwent baseline and at least one additional assessment of coronary calcification. At baseline, 37% of sevelamer treated and 31% of calcium treated patients had no evidence of coronary calcification. No subject with a zero coronary artery calcium score (CACS) at baseline progressed to a CACS >30 over 18 months. Subjects with a CACS > 30 at baseline showed progressive increases in CACS in both treatment arms (P < 0.05 for each time point in both groups). Subjects treated with calcium containing phosphate binders showed more rapid and more severe increases in CACS when compared with those receiving sevelamer hydrochloride (P = 0.056 at 12 months, P = 0.01 at 18 months). New hemodialysis patients with no evidence of coronary calcification showed little evidence of disease development over 18 months independent of phosphate binder therapy. However, subjects with evidence of at least mild coronary calcification had significant progression at 6, 12, and 18 months. Use of calcium containing phosphate binders resulted in more rapid progression of coronary calcification than did use of sevelamer hydrochloride.