Peritoneal dialysis patients using sevelamer do not present the acidosis problems that hemodialysis patients do

Acidosis is responsible for catabolic state in dialysis patients and should be avoided or corrected. The survival of patients on peritoneal dialysis (PD) is as good as that of patients on hemodialysis--if not better-mainly because PD patients are rarely in an acidotic-catabolic state as compared with hemodialysis patients. We investigated whether the use of sevelamer in PD patients contributes to significant acidosis as has been reported in the hemodialysis population. We compared serum bicarbonate in 12 PD patients on sevelamer and 77 PD patients not on that drug. Residual renal function, serum phosphate, and daily intake of calcium phosphate binder were also recorded. Patients on PD who take sevelamer maintain a serum bicarbonate level in the normal range as compared with hemodialysis patients, who frequently become acidotic. Serum bicarbonate is only slightly lower in PD patients taking sevelamer than in those not taking that drug.