The effects of sevelamer and calcium acetate on proxies of atherosclerotic and arteriosclerotic vascular disease in hemodialysis patients

被引:83
作者
Chertow, GM
Raggi, P
McCarthy, JT
Schulman, G
Silberzweig, J
Kuhlik, A
Goodman, WG
Boulay, A
Burke, SK
Toto, RD
机构
[1] Moffitt Long Hosp, Div Nephrol, San Francisco, CA USA
[2] Univ Calif San Francisco, Dept Med, Mt Zion Med Ctr, San Francisco, CA USA
[3] Tulane Univ, Dept Med, Div Cardiol, New Orleans, LA 70118 USA
[4] Mayo Clin, Dept Med, Div Nephrol, Rochester, MN USA
[5] Vanderbilt Univ, Dept Med, Div Nephrol, Nashville, TN USA
[6] Cornell Univ, Rogosin Inst, New York, NY USA
[7] Cornell Univ, Dept Med, Div Nephrol, New York, NY USA
[8] Beth Israel Deaconess Med Ctr, Dept Med, Div Nephrol, Boston, MA 02215 USA
[9] Univ Calif Los Angeles, Dept Med, Div Nephrol, Los Angeles, CA 90024 USA
[10] GeITex Pharmaceut Inc, Waltham, MA USA
[11] Univ Texas, SW Med Ctr, Dept Med, Div Nephrol, Dallas, TX USA
关键词
sevelamer; calcium; calcification; arteriosclerosis; clinical trial;
D O I
10.1159/000072822
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
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 greater than or equal to 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 9 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. Copyright (C) 2003 S. Karger AG, Basel.
引用
收藏
页码:307 / 314
页数:8
相关论文
共 40 条
[31]   Association of hyperphosphataemia with haemodynamic disturbances in end-stage renal disease [J].
Marchais, SJ ;
Metivier, F ;
Guerin, AP ;
London, GM .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 1999, 14 (09) :2178-2183
[32]  
Nauck M, 1996, CLIN NEPHROL, V46, P319
[33]  
Nolan CR, 2003, KIDNEY INT, V63, P383, DOI 10.1046/j.1523-1755.2003.t01-3-00746.x
[34]   CALCIUM ACETATE VERSUS CALCIUM-CARBONATE AS PHOSPHATE-BINDING AGENTS IN CHRONIC-HEMODIALYSIS [J].
PFLANZ, S ;
HENDERSON, IS ;
MCELDUFF, N ;
JONES, MC .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 1994, 9 (08) :1121-1124
[35]   Cardiac calcification in adult Hemodialysis patients - A link between end-stage renal disease and cardiovascular disease? [J].
Raggi, P ;
Boulay, A ;
Chasan-Taber, S ;
Amin, N ;
Dillon, M ;
Burke, SK ;
Chertow, GM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (04) :695-701
[36]  
RING T, 1993, NEPHROL DIAL TRANSPL, V8, P341
[37]   MANAGEMENT OF HYPERPHOSPHATEMIA WITH CALCIUM CITRATE IN HEMODIALYSIS-PATIENTS [J].
SAUPE, J ;
BELMEGA, G ;
KRAUSE, R ;
BENNHOLD, I .
NEPHRON, 1989, 52 (01) :93-94
[38]   REDUCTION OF DIETARY PHOSPHORUS ABSORPTION BY PHOSPHORUS BINDERS - A THEORETICAL, INVITRO, AND INVIVO STUDY [J].
SHEIKH, MS ;
MAGUIRE, JA ;
EMMETT, M ;
ANA, CAS ;
NICAR, MJ ;
SCHILLER, LR ;
FORDTRAN, JS .
JOURNAL OF CLINICAL INVESTIGATION, 1989, 83 (01) :66-73
[39]   CALCIUM-CARBONATE AS A PHOSPHATE BINDER IN PATIENTS WITH CHRONIC-RENAL-FAILURE UNDERGOING DIALYSIS [J].
SLATOPOLSKY, E ;
WEERTS, C ;
LOPEZHILKER, S ;
NORWOOD, K ;
ZINK, M ;
WINDUS, D ;
DELMEZ, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1986, 315 (03) :157-161
[40]  
Undas Anetta, 2002, Clin Lab, V48, P287