Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients

Treat to Goal Working Group

Research output: Contribution to journalArticle

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Abstract

Background. Cardiovascular disease is frequent and severe in patients with end-stage renal disease. Disorders of mineral metabolism may contribute by promoting cardiovascular calcification. Methods. We conducted a randomized clinical trial comparing sevelamer, a non-absorbed polymer, with calcium-based phosphate binders in 200 hemodialysis patients. Study outcomes included the targeted concentrations of serum phosphorus, calcium, and intact parathyroid hormone (PTH), and calcification of the coronary arteries and thoracic aorta using a calcification score derived from electron beam tomography. Results. Sevelamer and calcium provided equivalent control of serum phosphorus (end-of-study values 5.1 ± 1.2 and 5.1 ± 1.4 mg/dL, respectively, P = 0.33). Serum calcium concentration was significantly higher in the calcium-treated group (P = 0.002), and hypercalcemia was more common (16% vs. 5% with sevelamer, P = 0.04). More subjects in the calcium group had end-of-study intact PTH below the target of 150 to 300 pg/mL (57% vs. 30%, P = 0.001). At study completion, the median absolute calcium score in the coronary arteries and aorta increased significantly in the calcium treated subjects but not in the sevelamer-treated subjects (coronary arteries 36.6 vs. 0, P = 0.03 and aorta 75.1 vs. 0, P = 0.01, respectively). The median percent change in coronary artery (25% vs. 6%, P = 0.02) and aortic (28% vs. 5%, P = 0.02) calcium score also was significantly greater with calcium than with sevelamer. Conclusions. Compared with calcium-based phosphate binders, sevelamer is less likely to cause hypercalcemia, low levels of PTH, and progressive coronary and aortic calcification in hemodialysis patients.

Original languageEnglish (US)
Pages (from-to)245-252
Number of pages8
JournalKidney International
Volume62
Issue number1
DOIs
StatePublished - 2002

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Renal Dialysis
Calcium
Coronary Vessels
Parathyroid Hormone
Hypercalcemia
Phosphorus
Aorta
Serum
Sevelamer
X Ray Computed Tomography
Thoracic Aorta
Chronic Kidney Failure
Minerals
Polymers
Cardiovascular Diseases
Randomized Controlled Trials
Outcome Assessment (Health Care)

Keywords

  • Cardiovascular calcification
  • End-stage renal disease
  • Hypercalcemia
  • Mineral metabolism
  • Randomized clinical trial

ASJC Scopus subject areas

  • Medicine(all)
  • Nephrology

Cite this

Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. / Treat to Goal Working Group.

In: Kidney International, Vol. 62, No. 1, 2002, p. 245-252.

Research output: Contribution to journalArticle

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title = "Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients",
abstract = "Background. Cardiovascular disease is frequent and severe in patients with end-stage renal disease. Disorders of mineral metabolism may contribute by promoting cardiovascular calcification. Methods. We conducted a randomized clinical trial comparing sevelamer, a non-absorbed polymer, with calcium-based phosphate binders in 200 hemodialysis patients. Study outcomes included the targeted concentrations of serum phosphorus, calcium, and intact parathyroid hormone (PTH), and calcification of the coronary arteries and thoracic aorta using a calcification score derived from electron beam tomography. Results. Sevelamer and calcium provided equivalent control of serum phosphorus (end-of-study values 5.1 ± 1.2 and 5.1 ± 1.4 mg/dL, respectively, P = 0.33). Serum calcium concentration was significantly higher in the calcium-treated group (P = 0.002), and hypercalcemia was more common (16{\%} vs. 5{\%} with sevelamer, P = 0.04). More subjects in the calcium group had end-of-study intact PTH below the target of 150 to 300 pg/mL (57{\%} vs. 30{\%}, P = 0.001). At study completion, the median absolute calcium score in the coronary arteries and aorta increased significantly in the calcium treated subjects but not in the sevelamer-treated subjects (coronary arteries 36.6 vs. 0, P = 0.03 and aorta 75.1 vs. 0, P = 0.01, respectively). The median percent change in coronary artery (25{\%} vs. 6{\%}, P = 0.02) and aortic (28{\%} vs. 5{\%}, P = 0.02) calcium score also was significantly greater with calcium than with sevelamer. Conclusions. Compared with calcium-based phosphate binders, sevelamer is less likely to cause hypercalcemia, low levels of PTH, and progressive coronary and aortic calcification in hemodialysis patients.",
keywords = "Cardiovascular calcification, End-stage renal disease, Hypercalcemia, Mineral metabolism, Randomized clinical trial",
author = "{Treat to Goal Working Group} and Chertow, {Glenn M.} and Burke, {Steven K.} and Paolo Raggi and Chertow, {G. M.} and G. Caputo and P. Raggi and G. Schulman and A. Kuhlik and M. Derman and M. Clouse and McCarthy, {J. T.} and J. Breen and J. Silberzweig and J. Markisz and W. Goodman and J. Goldin and R. Toto and M. Boyce and J. Bommer and Neumayer, {H. H.} and R. Krause and G. Asmus and B. Hamm and R. Brunkhors and Gr{\"o}nemeyer, {D. H W} and W. Schulz and J. Braun and M. Georgi and S. Achenbach and W. Moshage and H. Holzer and R. Rienm{\"u}ller",
year = "2002",
doi = "10.1046/j.1523-1755.2002.00434.x",
language = "English (US)",
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pages = "245--252",
journal = "Kidney International",
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TY - JOUR

T1 - Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients

AU - Treat to Goal Working Group

AU - Chertow, Glenn M.

AU - Burke, Steven K.

AU - Raggi, Paolo

AU - Chertow, G. M.

AU - Caputo, G.

AU - Raggi, P.

AU - Schulman, G.

AU - Kuhlik, A.

AU - Derman, M.

AU - Clouse, M.

AU - McCarthy, J. T.

AU - Breen, J.

AU - Silberzweig, J.

AU - Markisz, J.

AU - Goodman, W.

AU - Goldin, J.

AU - Toto, R.

AU - Boyce, M.

AU - Bommer, J.

AU - Neumayer, H. H.

AU - Krause, R.

AU - Asmus, G.

AU - Hamm, B.

AU - Brunkhors, R.

AU - Grönemeyer, D. H W

AU - Schulz, W.

AU - Braun, J.

AU - Georgi, M.

AU - Achenbach, S.

AU - Moshage, W.

AU - Holzer, H.

AU - Rienmüller, R.

PY - 2002

Y1 - 2002

N2 - Background. Cardiovascular disease is frequent and severe in patients with end-stage renal disease. Disorders of mineral metabolism may contribute by promoting cardiovascular calcification. Methods. We conducted a randomized clinical trial comparing sevelamer, a non-absorbed polymer, with calcium-based phosphate binders in 200 hemodialysis patients. Study outcomes included the targeted concentrations of serum phosphorus, calcium, and intact parathyroid hormone (PTH), and calcification of the coronary arteries and thoracic aorta using a calcification score derived from electron beam tomography. Results. Sevelamer and calcium provided equivalent control of serum phosphorus (end-of-study values 5.1 ± 1.2 and 5.1 ± 1.4 mg/dL, respectively, P = 0.33). Serum calcium concentration was significantly higher in the calcium-treated group (P = 0.002), and hypercalcemia was more common (16% vs. 5% with sevelamer, P = 0.04). More subjects in the calcium group had end-of-study intact PTH below the target of 150 to 300 pg/mL (57% vs. 30%, P = 0.001). At study completion, the median absolute calcium score in the coronary arteries and aorta increased significantly in the calcium treated subjects but not in the sevelamer-treated subjects (coronary arteries 36.6 vs. 0, P = 0.03 and aorta 75.1 vs. 0, P = 0.01, respectively). The median percent change in coronary artery (25% vs. 6%, P = 0.02) and aortic (28% vs. 5%, P = 0.02) calcium score also was significantly greater with calcium than with sevelamer. Conclusions. Compared with calcium-based phosphate binders, sevelamer is less likely to cause hypercalcemia, low levels of PTH, and progressive coronary and aortic calcification in hemodialysis patients.

AB - Background. Cardiovascular disease is frequent and severe in patients with end-stage renal disease. Disorders of mineral metabolism may contribute by promoting cardiovascular calcification. Methods. We conducted a randomized clinical trial comparing sevelamer, a non-absorbed polymer, with calcium-based phosphate binders in 200 hemodialysis patients. Study outcomes included the targeted concentrations of serum phosphorus, calcium, and intact parathyroid hormone (PTH), and calcification of the coronary arteries and thoracic aorta using a calcification score derived from electron beam tomography. Results. Sevelamer and calcium provided equivalent control of serum phosphorus (end-of-study values 5.1 ± 1.2 and 5.1 ± 1.4 mg/dL, respectively, P = 0.33). Serum calcium concentration was significantly higher in the calcium-treated group (P = 0.002), and hypercalcemia was more common (16% vs. 5% with sevelamer, P = 0.04). More subjects in the calcium group had end-of-study intact PTH below the target of 150 to 300 pg/mL (57% vs. 30%, P = 0.001). At study completion, the median absolute calcium score in the coronary arteries and aorta increased significantly in the calcium treated subjects but not in the sevelamer-treated subjects (coronary arteries 36.6 vs. 0, P = 0.03 and aorta 75.1 vs. 0, P = 0.01, respectively). The median percent change in coronary artery (25% vs. 6%, P = 0.02) and aortic (28% vs. 5%, P = 0.02) calcium score also was significantly greater with calcium than with sevelamer. Conclusions. Compared with calcium-based phosphate binders, sevelamer is less likely to cause hypercalcemia, low levels of PTH, and progressive coronary and aortic calcification in hemodialysis patients.

KW - Cardiovascular calcification

KW - End-stage renal disease

KW - Hypercalcemia

KW - Mineral metabolism

KW - Randomized clinical trial

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U2 - 10.1046/j.1523-1755.2002.00434.x

DO - 10.1046/j.1523-1755.2002.00434.x

M3 - Article

C2 - 12081584

AN - SCOPUS:0036310682

VL - 62

SP - 245

EP - 252

JO - Kidney International

JF - Kidney International

SN - 0085-2538

IS - 1

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