[Experience with sevelamer in peritoneal dialysis].

Area of Science:

• Nephrology
• Internal Medicine
• Pharmacology

Background:

• Hyperphosphatemia is a common complication in peritoneal dialysis (PD) patients.
• Traditional phosphate binders like aluminum and calcium salts have potential adverse effects.
• Sevelamer, a non-aluminum, non-calcium-based phosphate binder, offers an alternative treatment option.

Purpose of the Study:

• To evaluate the efficacy of sevelamer in controlling serum phosphorus levels in PD patients.
• To assess changes in phosphorus binder requirements during sevelamer therapy.
• To examine the impact of sevelamer on serum phosphorus, calcium-x-phosphorus product, and lipid profiles.

Main Methods:

• A prospective study involving 14 PD patients with hyperphosphatemia previously treated with aluminum or calcium-based binders.
• Patients were initiated on sevelamer (400 mg) and followed for 12 months.
• Dosage adjustments were made as needed to achieve target phosphorus levels.

Main Results:

• Sevelamer therapy led to a significant reduction in serum phosphorus levels (from 5.9 to 5.0 mg/dL) and the calcium-x-phosphorus product (from 59.8 to 48.6 mg²/dL²).
• The use of aluminum and calcium salts was significantly reduced or eliminated.
• Serum cholesterol levels also decreased significantly, while serum triglycerides, CO2, and PTH remained stable. Alkaline phosphatase initially increased but normalized by 12 months.

Conclusions:

• Sevelamer provides effective control of hyperphosphatemia and the calcium-x-phosphorus product in PD patients.
• It facilitates a reduction in the use of aluminum and calcium-based phosphate binders.
• Sevelamer represents a valuable therapeutic option for managing mineral and bone disorders in PD patients.