Potential antiatherogenic and anti-inflammatory properties of sevelamer in maintenance hemodialysis patients

Am Heart J. 2005 May;149(5):820-5. doi: 10.1016/j.ahj.2004.07.023.

Abstract

Background: Patients affected by end-stage renal disease (ESRD) demonstrate a very high cardiovascular risk mediated by traditional cardiovascular risk factors as well as abnormal mineral metabolism and a state of chronic inflammation. Sevelamer is a nonabsorbable non-calcium-based hydrogel with potential antiatherosclerotic properties.

Method and results: One hundred eight patients undergoing maintenance hemodialysis were randomized to sevelamer or calcium acetate as treatment for hyperphosphatemia. A coronary artery calcium score, as a measure of plaque burden, was calculated at baseline and 1 year, along with serial measurements of serum lipoproteins, beta2-microglobulin, and high-sensitivity C-reactive protein (hs-CRP). At 1 year, coronary artery calcium score progressed significantly from baseline in calcium acetate-treated subjects ( P < .001) but not in sevelamer-treated patients (P = NS). Total cholesterol (P < .0001), low-density lipoprotein cholesterol (P < .0001), apolipoprotein B (P < .0001), beta2-microglobulin (P = .018), and hs-CRP (P < .002) decreased, and high-density lipoprotein increased significantly (P = .036) from baseline in the sevelamer-treated subjects but not in subjects treated with calcium acetate despite the more frequent use of statins in the latter group (46% vs 22%, P < .05). The changes in total and low-density lipoprotein cholesterol, apolipoprotein B, and hs-CRP were significantly different between treatment groups (all P < .01).

Conclusions: Sevelamer leads to favorable changes in lipids and inflammatory markers with potentially useful antiatherogenic effects in hemodialysis patients.

MeSH terms

  • Acetates / therapeutic use
  • Aged
  • Anti-Inflammatory Agents / therapeutic use*
  • C-Reactive Protein / drug effects
  • C-Reactive Protein / metabolism
  • Calcium Compounds
  • Coronary Artery Disease / prevention & control
  • Disease Progression
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Homocysteine / blood
  • Homocysteine / drug effects
  • Humans
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / therapy*
  • Lipoproteins / blood
  • Lipoproteins / drug effects
  • Male
  • Middle Aged
  • Phosphates / blood*
  • Phosphorus Metabolism Disorders / drug therapy*
  • Polyamines / therapeutic use*
  • Renal Dialysis*
  • Sevelamer
  • beta 2-Microglobulin / blood
  • beta 2-Microglobulin / drug effects

Substances

  • Acetates
  • Anti-Inflammatory Agents
  • Calcium Compounds
  • Fibrinolytic Agents
  • Lipoproteins
  • Phosphates
  • Polyamines
  • beta 2-Microglobulin
  • Homocysteine
  • C-Reactive Protein
  • Sevelamer
  • calcium acetate