The study included 17 CKD patients (cases) with and 18 CKD patients (comparisons) without
sevelamer crystals in specimens. All cases were on
sevelamer. Six comparison patients were also taking
sevelamer, but crystals were absent in tissue sections. The comparison group was thus subclassified into patients who were and were not taking
sevelamer. The frequency of underlying disorders was similar between two groups, including
hypertension (cases = 82%; comparisons = 78%) and
diabetes mellitus (cases = 53%, comparisons = 50%). The most common presentation was GI
bleeding (cases = 41%, comparisons = 33%). Predominant histological patterns were also similar, with
ulcers (cases = 42%; comparisons = 39%) and acute ischaemia (cases = 35%; comparisons = 28%) being predominant in both cohorts. Of note,
sevelamer was present with
amyloidosis and cytomegalovirus in one study case each. Two study patients who continued
sevelamer had follow-up biopsies; one showed persistent ulceration and the other appeared normal. Crystals were absent in both.
CONCLUSIONS: GI injury in CKD patients in both groups had similar features regardless of presence of
sevelamer, suggesting that it adheres to tissue rather than causes injury. The study highlights other histologically identifiable causes of intestinal injury, as well as
injuries unassociated with
sevelamer in patients undergoing
therapy. Therefore, physicians should be cautious in attributing GI
injuries to
sevelamer to avoid overlooking other causes and unnecessary treatment discontinuation.