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Effect of phosphate binders on serum inflammatory profile, soluble CD14, and endotoxin levels in hemodialysis

Juan F Navarro-González1, Carmen Mora-Fernández, Mercedes Muros de Fuentes

  • 1Research Unit, University Hospital Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain. jnavgon@gobiernodecanarias.org

Clinical Journal of the American Society of Nephrology : CJASN
|July 26, 2011
PubMed

Insights

Sevelamer, a phosphate binder, significantly reduced inflammation markers, endotoxin, and soluble CD14 (sCD14) in hemodialysis patients. Calcium acetate did not show these anti-inflammatory benefits.

Area of Science:

  • Nephrology
  • Inflammation Research
  • Biochemistry

Background:

  • Hyperphosphatemia and endotoxemia contribute to inflammation in hemodialysis (HD) patients.
  • Proinflammatory cytokines correlate with soluble CD14 (sCD14), a mortality predictor in HD.
  • Inflammatory profiles, endotoxin, and sCD14 levels were assessed in HD patients.

Purpose of the Study:

  • To evaluate the effects of calcium acetate and sevelamer hydrochloride on serum inflammatory markers.
  • To assess the impact of these binders on endotoxin and sCD14 concentrations in HD patients.

Main Methods:

  • A prospective, randomized, open-label trial involving 59 stable HD patients.
  • Patients received either sevelamer (n=30) or calcium acetate (n=29) for 3 months.
  • Serum levels of hs-CRP, TNF-α, IL-1, IL-6, IL-10, IL-18, endotoxin, and sCD14 were measured at baseline and after treatment.

Main Results:

  • Sevelamer significantly decreased high-sensitivity C-reactive protein (hs-CRP) and IL-6, with a trend towards increased IL-10.
  • Sevelamer treatment led to a significant reduction in serum endotoxin (22.6%) and sCD14 (15.2%) levels.
  • Calcium acetate treatment resulted in increased IL-6 and no significant changes in endotoxin or sCD14.

Conclusions:

  • Sevelamer administration in HD patients significantly reduces hs-CRP, IL-6, serum endotoxin, and sCD14 levels.
  • These findings suggest sevelamer possesses anti-inflammatory properties beyond phosphate binding.
  • Endotoxin levels were the strongest predictor of IL-6 changes, and IL-6 and endotoxin predicted sCD14 changes.
Abstract

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