Phosphate binder impact on bone remodeling and coronary calcification--results from the BRiC study

Nephron Clin Pract. 2008;110(4):c273-83. doi: 10.1159/000170783. Epub 2008 Nov 12.

Abstract

Background and aims: Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients. This is a prospective study that compares the effects of calcium acetate and sevelamer on coronary calcification (CAC) and bone histology.

Methods: 101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice coronary tomographies and bone biopsies at entry and 12 months.

Results: The 71 patients who concluded the study had similar baseline characteristics. On follow-up, the sevelamer group had higher levels of intact parathyroid hormone (498 +/- 352 vs. 326 +/- 236 pg/ml, p = 0.017), bone alkaline phosphatase (38 +/- 24 vs. 28 +/- 15 U/l, p = 0.03) and deoxypyridinoline (135 +/- 107 vs. 89 +/- 71 nmol/l, p = 0.03) and lower LDL cholesterol (74 +/- 21 vs. 91 +/- 28 mg/dl, p = 0.015). Phosphorus (5.8 +/- 1.0 vs. 6 +/- 1.0 mg/dl, p = 0.47) and calcium (1.27 +/- 0.07 vs. 1.23 +/- 0.08 mmol/l, p = 0.68) levels did not differ between groups. CAC progression (35 vs. 24%, p = 0.94) and bone histological diagnosis at baseline and 12 months were similar in both groups. Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption (eroded surface, ES/BS = 9.0 +/- 5.9 vs. 13.1 +/- 9.5%, p = 0.05), whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate (BFR/BS = 0.015 +/- 0.016 vs. 0.062 +/- 0.078, p = 0.003 for calcium and 0.017 +/- 0.016 vs. 0.071 +/- 0.084 microm(3)/microm(2)/day, p = 0.010 for sevelamer).

Conclusions: There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetates / administration & dosage*
  • Bone Remodeling / drug effects*
  • Brazil / epidemiology
  • Calcinosis / epidemiology*
  • Calcium Compounds / administration & dosage
  • Chelating Agents / administration & dosage
  • Comorbidity
  • Coronary Artery Disease / epidemiology*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Polyamines / administration & dosage*
  • Renal Dialysis / statistics & numerical data*
  • Sevelamer
  • Treatment Outcome

Substances

  • Acetates
  • Calcium Compounds
  • Chelating Agents
  • Polyamines
  • Sevelamer
  • calcium acetate