Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients

Kidney Int. 2007 Nov;72(9):1130-7. doi: 10.1038/sj.ki.5002466. Epub 2007 Aug 29.


Elevated serum phosphorus and calcium are associated with arterial calcification and mortality in dialysis patients. Unlike calcium-based binders, sevelamer attenuates arterial calcification but it is unknown whether sevelamer affects mortality or morbidity. In a multicenter, randomized, open-label, parallel design trial we compared sevelamer and calcium-based binders on all-cause and cause-specific mortality (cardiovascular, infection, and other) in prevalent hemodialysis patients. A total of 2103 patients were initially randomized to treatment and 1068 patients completed the study. All-cause mortality rates and cause-specific mortality rates were not significantly different. There was a significant age interaction on the treatment effect. Only in patients over 65 years of age was there a significant effect of sevelamer in lowering the mortality rate. There was a suggestion that sevelamer was associated with lower overall, but not cardiovascular-linked, mortality in older patients. We suggest that further research is needed to confirm these findings.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetates / adverse effects
  • Acetates / therapeutic use*
  • Adult
  • Age Factors
  • Aged
  • Calcium / blood
  • Calcium Carbonate / adverse effects
  • Calcium Carbonate / therapeutic use*
  • Calcium Compounds / adverse effects
  • Calcium Compounds / therapeutic use
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control*
  • Chelating Agents / adverse effects
  • Chelating Agents / therapeutic use*
  • Chronic Disease
  • Female
  • Humans
  • Kidney Diseases / complications
  • Kidney Diseases / therapy*
  • Male
  • Middle Aged
  • Phosphorus / blood
  • Polyamines / adverse effects
  • Polyamines / therapeutic use*
  • Renal Dialysis / mortality*
  • Sevelamer
  • Treatment Outcome


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