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Short-term treatment with sevelamer increases serum fetuin-a concentration and improves endothelial dysfunction in

Kayser Caglar1, Mahmut Ilker Yilmaz, Mutlu Saglam

  • 1Department of Nephrology, Gülhane School of Medicine, Etlik-Ankara, Turkey.

Clinical Journal of the American Society of Nephrology : CJASN
|December 7, 2007
PubMed

Insights

Sevelamer treatment in chronic kidney disease (CKD) patients significantly increased fetuin-A levels and improved flow-mediated dilation (FMD), suggesting a potential mechanism for cardiovascular benefit.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Biochemistry

Background:

  • Vascular calcification and endothelial dysfunction are key contributors to cardiovascular disease in chronic kidney disease (CKD).
  • Sevelamer, a non-calcium-based phosphate binder, is known to reduce cardiovascular calcification in CKD patients, but its precise mechanism remains unclear.
  • This study investigated the impact of sevelamer on serum fetuin-A and endothelial function in CKD patients.

Purpose of the Study:

  • To determine the effect of short-term sevelamer treatment on serum fetuin-A concentrations.
  • To assess the impact of sevelamer on endothelial dysfunction (measured by flow-mediated dilation, FMD).
  • To explore the relationship between fetuin-A levels and FMD in CKD patients.

Main Methods:

  • A randomized prospective study involving 50 nondiabetic stage 4 CKD patients with elevated phosphate levels.
  • Patients were treated for 8 weeks with either sevelamer (n=25) or calcium acetate (n=25).
  • Measurements included serum fetuin-A, Ca x PO4 product, FMD, and high-sensitivity C-reactive protein at baseline and post-treatment.

Main Results:

  • CKD patients exhibited lower fetuin-A and FMD, and higher Ca x PO4 product and hs-CRP compared to controls.
  • Sevelamer treatment significantly increased fetuin-A levels and improved FMD.
  • No significant changes in FMD or fetuin-A were observed in the calcium acetate group.
  • Multiple regression analysis revealed FMD was independently associated with fetuin-A levels both before and after treatment.

Conclusions:

  • Short-term sevelamer treatment effectively increases serum fetuin-A concentrations in nondiabetic stage 4 CKD patients.
  • Sevelamer administration also leads to significant improvements in endothelial function (FMD).
  • These findings suggest that increased fetuin-A levels may mediate the beneficial effects of sevelamer on endothelial function in CKD.
Abstract

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