New strategy to attenuate pulse wave velocity in haemodialysis patients

Background. Pulse wave velocity (PWV) is commonly elevated in haemodialysis (HD) patients having cardiovascular diseases. Disturbances in calcium-phosphate metabolism are among the established cardiovascular risk factors in HD patients. The present study was performed to assess the effect of sevelamer on PWV in HD patients. Methods. Fifteen patients, who had been treated with calcium carbonate as a phosphate binder, were entered into the study. Changes in PWV during the 6 months before sevelamer administration were compared with PWV changes during 6 months of receiving sevelamer. Serum biochemistry parameters were also assessed. Results. Compared with the preceding control period, the sevelamer period resulted in decreased serum calcium (9.9 +/- 0.1 to 9.6 +/- 0.1 mg/dl, n = 15; P < 0.01) in association with reductions in oral calcium load (4.3 +/- 0.4 to 2.3 +/- 0.6 g/day; P < 0.001). Serum phosphorus and whole parathyroid hormone remained unchanged. Sevelamer reduced serum total cholesterol (167 +/- 7 to 148 +/- 6 mg/dl; P < 0.001) and LDL-cholesterol (85 +/- 8 to 65 +/- 7 mg/dl; P < 0.001), without modifying HDL-cholesterol or triglycerides. Finally, sevelamer reversed the increase in PWV observed during the control period (from 46 16 to -20 +/- 9 cm/s/month; P < 0.01). Conclusions. In chronic HD patients, sevelamer decreased serum total- and LDL-cholesterol as well as calcium. Moreover, our findings suggest that treatment with sevelamer attenuates the progressive increase in PWV observed during calcium carbonate treatment.