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Impact of phosphate binder type on coronary artery calcification in hemodialysis patients

R Shantouf1, N Ahmadi, F Flores

  • 1Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.

Clinical Nephrology
|June 19, 2010
PubMed

Insights

Calcium-free sevelamer use in maintenance hemodialysis patients was associated with lower coronary artery calcification (CAC) compared to calcium-based phosphate binders (CBPB). This finding suggests sevelamer may be a safer option for managing phosphate levels and cardiovascular risk in CKD patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Coronary artery calcification (CAC) is highly prevalent in chronic kidney disease (CKD) patients, particularly those on maintenance hemodialysis (MHD).
  • Phosphate binders are crucial for managing hyperphosphatemia in CKD, but their impact on cardiovascular calcification varies.
  • Calcium-based phosphate binders (CBPB) have been linked to increased calcification, prompting research into alternatives like calcium-free binders.

Purpose of the Study:

  • To investigate the association between sevelamer (a calcium-free phosphate binder) and coronary artery calcification (CAC) in MHD patients.
  • To compare CAC scores in MHD patients treated with sevelamer versus those treated with CBPB.
  • To determine if sevelamer monotherapy is associated with reduced CAC compared to CBPB monotherapy in MHD patients.

Main Methods:

  • A cross-sectional study involving 117 maintenance hemodialysis (MHD) patients.
  • Patients were categorized into two groups: those taking only CBPB (n=60) and those taking only sevelamer (n=57).
  • Coronary artery calcium scores (CACS) were assessed using computerized tomography; logistic regression analyzed the odds of significant CAC.

Main Results:

  • Despite a higher prevalence of diabetes mellitus (DM) in the sevelamer group (58% vs. 35%), CACS was significantly lower in sevelamer users (283 ± 83) compared to CBPB users (494 ± 94; p=0.02).
  • After adjusting for covariates, CBPB use was associated with significantly higher odds of severe CAC (CACS ≥ 400) compared to sevelamer use (OR=4.35; 95% CI: 1.5-9.9; p=0.008).

Conclusions:

  • Significant coronary artery calcification (CAC) is more prevalent in maintenance hemodialysis (MHD) patients treated with calcium-based phosphate binders (CBPB) compared to those on sevelamer monotherapy.
  • These findings suggest that calcium-free phosphate binders like sevelamer may play a role in mitigating cardiovascular calcification in MHD patients.
  • Further prospective studies are warranted to confirm the cardiovascular benefits of sevelamer in this high-risk population.
Abstract

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