IngentaConnect Influence of Sevelamer on Mineral Metabolism and Hyperparathyroid...

Authors: Inoue, Toru; Nagatoya, Katsuyuki¹; Kagitani, Maki¹; Shibahara, Nobuhisa¹; Ueda, Haruhiko²; Katsuoka, Yoji²; Ohashi, Seiji³; Kitagawa, Yoshiyuki⁴; Nishimoto, Kazuhiko⁵; Yasuda, Hideaki⁶

Source: Therapeutic Apheresis and Dialysis, Volume 11, Number 3, June 2007 , pp. 210-214(5)

Publisher: Blackwell Publishing

Abstract:

In June 2003, sevelamer hydrochloride became widely available in Japan and was expected to control hyperphosphatemia in hemodialysis patients without inducing hypercalcemia. To evaluate the impact of sevelamer therapy on mineral metabolism, we recruited 954 hemodialysis patients from 21 renal units just before the general release of sevelamer in Japan. The serum calcium, phosphate, and parathyroid hormone levels determined on enrollment were compared with those later measured in June 2004. Sevelamer was prescribed for 169 of the 859 patients for whom data were available in 2004. The mean calcium level, phosphate level, and calcium × phosphate product were all significantly reduced during the 12-month study period, but the intact parathyroid hormone (iPTH) level did not change. As a result, the percentage of patients who achieved a calcium × phosphate product of <55 mg²/dL² was significantly increased, but there were no changes in that of patients who achieved the target ranges for phosphate (3.5-5.5 mg/dL) or iPTH (150-300 pg/mL). Among sevelamer-treated patients, iPTH significantly increased, and this change was more marked in the patients with an initial iPTH level <150 pg/mL. Sevelamer was useful for reducing the serum calcium level and calcium × phosphate product, but hyperphosphatemia and hyperparathyroidism were not improved in our study population at 12 months after the release of sevelamer. A decrease in the calcium load might result in the exacerbation of hyperparathyroidism. However, among patients with relative hypoparathyroidism, sevelamer therapy may be beneficial for the prevention of adynamic bone disease.

Keywords: Calcium × phosphate product; Hemodialysis; Hyperphosphatemia; Parathyroid hormone; Sevelamer hydrochloride

Document Type: Research article

DOI: 10.1111/j.1744-9987.2007.00468.x

Affiliations: 1: Blood Purification Center and 2: Department of Urology, Osaka College of Medicine, 3: Takatsuki Hospital, 4: Kitagawa Clinic, 5: Nishimoto Clinic, and 6: Sanko Hospital, Osaka, Japan

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Influence of Sevelamer on Mineral Metabolism and Hyperparathyroidism in Japanese Hemodialysis Patients