Korean J Clin Pharm.  2016 Jun;26(2):97-106. 10.0000/kjcp.2016.26.2.97.

Management of Chronic Kidney Disease-Mineral Bone Disorder with Sevelamer Hcl Phosphate Binder in Korean Patients with Dialysis

• Shin SW
• Sin HY

• KMID: 2358061
• DOI: http://doi.org/10.0000/kjcp.2016.26.2.97

Abstract

BACKGROUND
Sevelamer is associated with reduced complications of chronic kidney disease-mineral bone disorder (CKD-MBD) resulted from hyperphosphatemia, which may contribute mortality, in CKD patients with dialysis. So far clinical outcomes of sevelamer on mortality and risk of cardiovascular mortality related to CKD-MBD are debating. Purpose of this study was to evaluate the effectiveness of sevelamer HCl on mortality of secondary hyperparathyroidism (SHPT), risk of cardiovascular mortality and, frequency of osteopathy in end stage renal disease (ESRD) patients with dialysis.
METHODS
We retrospectively reviewed the electronic medical records of 536 patients with ESRD, who were admitted for moderate to severe SHPT, for 36 months. 75 patients who met inclusion criteria were evaluated for the efficacy of sevelamer (mean serum iPTH = 487.5 pg/mL).
RESULTS
Sevelamer intervention was not associated with increased three-year survival time compared with non-sevelamers group [average survival month: 30.4 months in sevelamer group, 26.8 months in non-sevelamer group, p = 0.463]. Sevelamer intervention was not associated with significant mortality benefit and cardiovascular mortality benefit as compared to non-sevelamer group [sevelamer group: non-sevelamer group, all-cause mortality (iPTH > 600 pg/mL): 14.3% (1/34): 20% (1/41) p = 0.962, OR = 0.935, 95% CI, 0.058-14.98, heart disease mortality: 6.67% (2/30): 0% (0/32) p = 0.138]. Sevelamer was not associated with significantly lower cumulative incidence of osteopathy compared to non-sevelamer group (sevelamer group: non-sevelamer group, 5.9% (2/34):9.8% (4/41); p = 0.538; OR = 0.578; 95% CI, 0.099-3.367).
CONCLUSION
Sevelamer was not associated with decreased all-cause mortality and risk of cardiovascular mortality compared to non-sevelamer group in ESRD patients with SHPT.

Keyword

Chronic kidney disease-mineral bone disease; sevelamer; intact parathyroid hormone; secondary hyperparathyroidism; cardiovascular disease

MeSH Terms

Cardiovascular Diseases
Dialysis*
Electronic Health Records
Heart Diseases
Humans
Hyperparathyroidism, Secondary
Hyperphosphatemia
Incidence
Kidney Failure, Chronic
Kidney*
Mortality
Retrospective Studies
Sevelamer*
Sevelamer