EFFICACY AND SAFETY OF SEVELAMER CARBONATE VERSUS CALCIUM ACETATE IN PATIENTS WITH CHRONIC RENAL DISEASE ON DIALYSIS
Abstract
Purpose: Powdered sevelamer carbonate is a new phosphate binder with unproven therapeutic benefit in Indian population. Hence, we aimed to compare its efficacy and safety with calcium acetate in patients with Chronic Renal Disease on hemodialysis.
Methods: This was a randomized, prospective, cross over and open labeled study, conducted in the Department of Nephrology, Christian Medical College and Hospital, Ludhiana. Fifty patients were included in data analysis and were randomization into two groups, A & B. Group A patients first received powdered sevelamer carbonate for 4 weeks (n= 25) followed by 1 week of washout and calcium acetate for the next 4 weeks (n=25). Group B: vice-versa. Serum phosphorus, calcium, C-reactive protein (CRP), total cholesterol, triglycerides (TGs) and low density lipoprotein (LDL) levels were performed before and after each drug was administered.
Results: Mean baseline serum phosphorus and calcium phosphorus product in group A, reduced from 6.59 ± 0.31mg/dl & 53.18 ± 2.5mg2/dl2 to 5.26± 0.33mg/dl & 44.76mg2/dl2 respectively. In group B these reduced from 6.42±0.33 mg/dl & 52.06±2.5 mg2/dl2 to 5.44±0.3 mg/dl & 44.5mg2/dl2 respectively. The reduction in these values in both groups was statistically significant (p<0.05). Reductions in serum CRP, total cholesterol, triglycerides and low density lipoprotein (LDL) levels were not statistically significant in either group.
Conclusion: Powdered sevelamer carbonate and calcium acetate are equally efficacious with no serious adverse effects. Both the drugs were well tolerated. Hence, powdered sevelamer carbonate can be a useful alternate to calcium based binders in Indian patients.
Keywords: powdered sevelamer carbonate, calcium acetate
DOI
https://doi.org/10.22270/jddt.v6i4.1273References
Cayir A, Kosan C, Growth hormone therapy in children with chronic renal failure, Eurasian J Med, 2015, 47(1), 62–5.
Reddy YN, Sundaram V, Abraham G, Nagarajan P, Reddy YN, Optimal management of hyperphosphatemia in end-stage renal disease: an Indian perspective, Int J Nephrol Renov Dis, 2014,7,391–9.
Bureo JC, Arévalo JC, Antón J, Adrados G, Jiménez Morales JL, Robles NR, et al, Prevalence of secondary hyperparathyroidism in patients with stage 3 and 4 chronic kidney disease seen in internal medicine, Endocrinol Nutr, 2015, 62(7):300-5
Wang S, Qin L, Wu T, Deng B, Sun Y, Hu D, et al, Elevated cardiac markers in chronic kidney disease as a consequence of hyperphosphatemia-induced cardiac myocyte injury, Med Sci Monit, 2014, 20, 2043–53.
Waheed AA, Pedraza F, Lenz O, Isakova T, Phosphate control in end-stage renal disease: barriers and opportunities, Nephrol Dial Transplant, 2013, 28(12), 2961–8.
Nguyen HV, Bose S, Finkelstein E, Incremental cost-utility of sevelamer relative to calcium carbonate for treatment of hyperphosphatemia among pre-dialysis chronic kidney disease patients, BMC Nephrol, 2016,17(1), 45.
Chen N, Wu X, Ding X, Mei C, Fu P, Jiang G, et al, Sevelamer carbonate lowers serum phosphorus effectively in haemodialysis patients: a randomized, double-blind, placebo-controlled, dose-titration study, Nephrol Dial Transplant, 2014, 29(1), 152–60.
Sandler NG, Zhang X, Bosch RJ, Funderburg NT, Choi AI, Robinson JK, et al, Sevelamer does not decrease lipopolysaccharide or soluble CD14 levels but decreases soluble tissue factor, low-density lipoprotein (LDL) cholesterol, and oxidized LDL cholesterol levels in individuals with untreated HIV infection, J Infect Dis, 2014, 210(10),1549–54.
Rastogi A, Sevelamer revisited: pleiotropic effects on endothelial and cardiovascular risk factors in chronic kidney disease and end-stage renal disease, Ther Adv Cardiovasc Dis, 2013 ,7(6),322–42.
Cai C, Hua W, Ding L-G, Wang J, Chen K-P, Yang X-W, et al, High sensitivity C-reactive protein and cardfiac resynchronization therapy in patients with advanced heart failure, J Geriatr Cardiol JGC, 2014 , 11(4), 296–302.
Nakata T, Hashimoto A, Moroi M, Tamaki N, Nishimura T, Hasebe N, et al, Sudden death prediction by C-reactive protein, electrocardiographic findings, and myocardial fatty acid uptake in haemodialysis patients: analysis of a multicentre prospective cohort sub-study, Eur Heart J Cardiovasc Imaging, 2015 Dec 27. pii: jev294. [Epub ahead of print]
Genovesi S, Valsecchi MG, Rossi E, Pogliani D, Acquistapace I, De Cristofaro V, et al, Sudden death and associated factors in a historical cohort of chronic haemodialysis patients, Nephrol Dial Transplant , 2009 , 24(8):2529–36.
Abraham G, Saxena S, Chafekar D, Shetty M, Reddy YNV, Kher V, et al, Sevelamer carbonate experience in Indian end stage renal disease patients, Indian J Nephrol, 2012;22(3):189.
Gulati A, Sridhar V, Bose T, Hari P, Bagga A, Short-term efficacy of sevelamer versus calcium acetate in patients with chronic kidney disease stage 3-4, Int Urol Nephrol, 2010, 42(4),1055–62.
Foster MC, Hwang S-J, Massaro JM, Jacques PF, Fox CS, Chu AY, Lifestyle Factors and Indices of Kidney Function in the Framingham Heart Study, Am J Nephrol, 2015, 20;41(4–5):267–74.
Anupama YJ, Uma G, Prevalence of chronic kidney disease among adults in a rural community in South India: Results from the kidney disease screening (KIDS) project, Indian J Nephrol, 2014;24(4):214–21.
Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al, What do we know about chronic kidney disease in India: first report of the Indian CKD registry, BMC Nephrol, 2012;13:10.
Mani MK, Experience with a program for prevention of chronic renal failure in India, Kidney Int Suppl. 2005, (94):S75-78.
Evenepoel P, Selgas R, Caputo F, Foggensteiner L, Heaf JG, Ortiz A, et al, Efficacy and safety of sevelamer hydrochloride and calcium acetate in patients on peritoneal dialysis, Nephrol Dial Transplant , 2009, 24(1):278–85.
Pieper A-K, Haffner D, Hoppe B, Dittrich K, Offner G, Bonzel K-E, et al, A randomized crossover trial comparing sevelamer with calcium acetate in children with CKD, Am J Kidney Dis, 2006,47(4):625–35.
Tonelli M, Wiebe N, Culleton B, Lee H, Klarenbach S, Shrive F, et al, Systematic review of the clinical efficacy and safety of sevelamer in dialysis patients, Nephrol Dial Transplant, 2007, 22(10):2856–66.
Silbernagel G, Baumgartner I, Wanner C, März W, Toward individualized cholesterol-lowering treatment in end-stage renal disease, J Ren Nutr, 2014, 24(2):65–71.
Li W-J, Chen X-M, Nie X-Y, Zhang J, Cheng Y-J, Lin X-X, et al, Cardiac troponin and C-reactive protein for predicting all-cause and cardiovascular mortality in patients with chronic kidney disease: A meta-analysis. Clin São Paulo Braz, 2015,70(4):301–11.
Yusuf AA, Weinhandl ED, St Peter WL, Comparative effectiveness of calcium acetate and sevelamer on clinical outcomes in elderly hemodialysis patients enrolled in Medicare part D, Am J Kidney Dis, 2014, 64(1):95–103.
de Francisco ALM, Leidig M, Covic AC, Ketteler M, Benedyk-Lorens E, Mircescu GM, et al, Evaluation of calcium acetate/magnesium carbonate as a phosphate binder compared with sevelamer hydrochloride in haemodialysis patients: a controlled randomized study (CALMAG study) assessing efficacy and tolerability, Nephrol Dial Transplant, 2010, 25(11):3707–17.
Published
Abstract Display: 609
PDF Downloads: 860 How to Cite
Issue
Section
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).

.