Effects of sevelamer hydrochloride and calcium carbonate on renal osteodystrophy in hemodialysis patients

被引:132
作者
Ferreira, Anibal [2 ]
Frazo, Joao Miguel [3 ,4 ]
Monier-Faugere, Marie-Claude [1 ]
Gil, Celia
Galvao, Jose [5 ]
Oliveira, Carlos [6 ]
Baldaia, Jorge [7 ]
Rodrigues, Ilidio [8 ]
Santos, Carla [9 ]
Ribeiro, Silvia [10 ]
Hoenger, Regula Mueller [11 ]
Duggal, Ajay [11 ]
Malluche, Hartmut H. [1 ]
机构
[1] Univ Kentucky, Med Ctr, Div Nephrol Bone & Mineral Metab, Lexington, KY 40536 USA
[2] Hosp Curry Cabral, Dept Nephrol, Lisbon, Portugal
[3] Univ Porto, Nephrol Res & Dev Unit, P-4100 Oporto, Portugal
[4] Univ Porto, Sch Med, P-4100 Oporto, Portugal
[5] FMC Torres Vedras, Torres Vedras, Portugal
[6] FMC Entrocamento, Entrocamento, Portugal
[7] Unidade Hemodialise Sta Casa Mesericordia Vila Ve, Guimaraes, Portugal
[8] Tagus Dial Barreiro FMC, Tagus Dial Barreiro, Barreiro, Portugal
[9] Ctr Hemodialise Sta Casa Mesericordia Vila Verde, Vila Verde, Portugal
[10] HPA, Almada, Portugal
[11] Genzyme Europe Res, Cambridge, England
来源
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2008年 / 19卷 / 02期
关键词
D O I
10.1681/ASN.2006101089
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Disturbances in mineral metabolism play a central role in the development of renal bone disease. In a 54-wk, randomized, open-label study, 119 hemodialysis patients were enrolled to compare the effects of sevelamer hydrochloride and calcium carbonate on bone. Biopsy-proven adynamic bone disease was the most frequent bone abnormality at baseline (59%). Serum phosphorus, calcium, and intact parathyroid hormone were well controlled in both groups, although calcium was consistently lower and intact parathyroid hormone higher among patients who were randomly assigned to sevelamer. Compared with baseline values, there were no changes in mineralization lag time or measures of bone turnover (e.g., activation frequency) after 1 yr in either group. Osteoid thickness significantly increased in both groups, but there was no significant difference between them. Bone formation rate per bone surface, however, significantly increased from baseline only in the sevelamer group (P = 0.019). In addition, of those with abnormal microarchitecture at baseline (i.e., trabecular separation), seven of 10 in the sevelamer group normalized after 1 yr compared with zero of three in the calcium group. In summary, sevelamer resulted in no statistically significant changes in bone turnover or mineralization compared with calcium carbonate, but bone formation increased and trabecular architecture improved with sevelamer. Further studies are required to assess whether these changes affect clinical outcomes, such as rates of fracture.
引用
收藏
页码:405 / 412
页数:8
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