Expert opinion on the optimal use of sevelamer in clinical practice in Southeast Asia
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Bancha Satirapoj1, Chong Men Leong2, Christopher Thiam Seong Lim3
1Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
Insights
Sevelamer effectively manages chronic kidney disease (CKD)-mineral bone disorder (MBD) by controlling phosphate levels without worsening calcium issues. This non-calcium-based binder offers additional benefits, making it a preferred treatment for CKD-MBD patients.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Chronic kidney disease (CKD)-mineral bone disorder (MBD) is a serious complication in advanced CKD patients, especially in Southeast Asia.
- CKD-MBD significantly elevates risks of cardiovascular events and mortality.
- Hyperphosphatemia is a key feature requiring effective management.
Purpose of the Study:
- To review the role of sevelamer, a non-calcium-based phosphate binder, in managing CKD-MBD.
- To synthesize evidence on sevelamer's efficacy, safety, and pleiotropic effects.
- To examine regional data from Southeast Asia regarding CKD-MBD management with sevelamer.
Main Methods:
- Systematic review of mechanistic insights and clinical trial evidence.
- Analysis of guideline recommendations and expert opinions.
- Inclusion of regional epidemiological and clinical practice data from Southeast Asia.
Main Results:
- Sevelamer effectively controls hyperphosphatemia without causing hypercalcemia or vascular calcification.
- Additional benefits include improved lipid profiles, reduced vascular inflammation, and potential survival advantages.
- Long-term safety and efficacy are demonstrated, particularly in high-risk CKD populations.
Conclusions:
- Sevelamer is a preferred therapeutic option for CKD-MBD due to its efficacy and favorable safety profile.
- Pleiotropic benefits beyond phosphate binding enhance its clinical value.
- Optimizing sevelamer use in Southeast Asia requires addressing accessibility, physician education, and health policies.
Abstract:
Chronic kidney disease (CKD)-mineral bone disorder (MBD) is a prevalent and serious complication in patients with advanced CKD, particularly in Southeast Asia where the disease burden is high. This condition significantly increases the risk of cardiovascular events and mortality. This review synthesizes mechanistic insights, clinical trial evidence, guideline recommendations, and expert perspectives to evaluate the role of sevelamer, a non-calcium-based phosphate binder, in the management of CKD-MBD. Regional epidemiological and clinical practice data from Southeast Asia were also examined. Sevelamer effectively controls hyperphosphatemia without exacerbating hypercalcemia or vascular calcification. Beyond phosphate binding, it offers pleiotropic benefits including improvements in lipid profile, reductions in vascular inflammation, and potential survival advantages. Despite challenges such as higher cost and pill burden, long-term safety and efficacy have been consistently demonstrated, particularly in high-risk CKD populations. Sevelamer represents a preferred therapeutic option in the management of CKD-MBD due to its efficacy and favorable safety profile. Insights from Southeast Asia highlight the need for improved accessibility, physician education, and supportive health policies to optimize its use in real-world practice.
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