Meta-analysis of the effect of sevelamer on phosphorus, calcium, PTH, and serum lipids in dialysis patients.

Abstract

Hyperphosphatemia and dyslipidemia are common clinically significant conditions in end-stage renal disease (ESRD). Hyperphosphatemia management is essential; however, use of calcium-based phosphate binder has been associated with elevated risk of cardiac calcification in ESRD, increasing risks for cardiovascular disease and death. An alternative to calcium-based phosphate binders is sevelamer hydrochloride, a calcium-free, metal-free, nonabsorbed polymer that binds phosphate effectively. We conducted a meta-analysis on the effects of sevelamer hydrochloride on parameters of mineral metabolism (serum phosphorous, calcium, Ca x P, and iPTH) and the lipid profile (total, LDL, HDL, and non-HDL cholesterol, and triglycerides) in dialysis patients. After application of inclusion/exclusion criteria, 17 core studies were statistically analyzed to determine the sevelamer treatment effect on the study parameters as demonstrated by simple, n-weighted, and inverse variance-weighted mean changes. Analysis of inverse variance-weighted mean changes indicated that sevelamer treatment was associated with a 2.14 mg/dL drop in serum phosphorus (P <.001), no significant overall effect on calcium (0.09 mg/dL, P =.364), significant decline in Ca x P product (15.91 mg(2)/dL(2), P <.001), 35.99 pg/mL reduction in iPTH (P =.026), significant reduction in total cholesterol (30.58 mg/dL, P <.001), 31.38 mg/dL drop in LDL cholesterol (P <.001), significant increase in HDL cholesterol (4.09 mg/dL, P =.008), and a significant reduction in triglycerides (22.04 mg/dL, P x.001). This meta-analysis suggests that sevelamer offers a dual therapeutic benefit in dialysis patients-a population at high risk for cardiovascular disease-by improving phosphorus control and the lipid profile, without altering serum calcium.

• Authors: Steven K Burke, Maureen A Dillon, Douglas E Hemken, Margit S Rezabek, James M Balwit
• Journal: Advances in renal replacement therapy (Adv Ren Replace Ther) Vol. 10 Issue 2 Pg. 133-45 (Apr 2003) ISSN: 1073-4449 [Print] United States
• PMID: 12879374 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright 2003 by the National Kidney Foundation, Inc.

Chemical References

• Epoxy Compounds
• Lipids
• Parathyroid Hormone
• Polyamines
• Polyethylenes
• Phosphorus
• Sevelamer
• Calcium

Topics

• Calcium (blood)
• Epoxy Compounds (therapeutic use)
• Humans
• Kidney Failure, Chronic (blood, therapy)
• Lipids (blood)
• Parathyroid Hormone (blood)
• Phosphorus (blood)
• Polyamines
• Polyethylenes (therapeutic use)
• Renal Dialysis
• Sevelamer