Pre-Treatment of Dairy and Breast Milk with Sevelamer Hydrochloride and Sevelamer Carbonate to Reduce Phosphate

Abstract

♦ Introduction: Young children and infants with chronic kidney disease are at increased risk of hyperphosphatemia because of high intake of dairy products. Hyperphos phatemia leads to metastatic calcifications and an increased risk of cardiovascular complications. Sevelamer is an effec tive phosphate binder, but for children it has important practical disadvantages: it clogs enteral feeding tubes and can cause gastrointestinal complaints. Pretreatment of dairy products to reduce their phosphate content might solve those problems. ♦ Methods: Sevelamer hydrochloride and sevelamer carbon ate were suspended in various dairy products (cow's milk, breast milk, baby formula, and tubefeeding formula). Each product was tested with varying concentrations of sevelamer. After suspension, each sample was stored for 10 minutes, allowing the sevelamer to precipitate. The supernatant was decanted and analyzed for pH and for phosphate, calcium, magnesium, potassium, sodium, and chloride content. ♦ Results: We observed a significant decrease in the phosphate content of all tested products. With sevelamer hydrochloride, the phosphate reduction was 48% -91% in the various products, and with sevelamer carbonate, it was 22% -87%. The highest effectiveness was found in breast milk. A pH increase was found in all products. With sevelamer hydrochloride, a significant increase in chloride occurred. Notably, a significant decrease in calcium content (-75%) was observed in treated breast milk. ♦ Conclusions: Pretreatment of a variety of dairy products with either sevelamer hydrochloride or sevelamer carbon ate effectively reduced their phosphate content and might avoid troublesome ingestion of sevelamer in children. The change in pH with sevelamer hydrochloride was remark able, reflecting buffering mechanisms. The reduction in the calcium content of breast milk is a potential concern and should be carefully considered and monitored during clinical use of sevelamer.

Renal formulas pretreated with medications alters the nutrient profile

“…The experimental protocols with doses and treatment times were based on previous work with SPS and sevelamer (Table 1) [3–6, 8–12]. The goals of this study were: (1) to evaluate whether nutrients other than potassium and phosphorus are affected in formulas pretreated with SPS and sevelamer carbonate, respectively; (2) to determine whether treating formula with SPS for 60 min causes a significant reduction in potassium concentration compared to a 30 min treatment; (3) to determine whether the co-administration of SPS and sevelamer carbonate in Suplena ® is effective at reducing potassium and phosphorus simultaneously.…”

“…In such cases, renal formulas are commonly treated with medications, such as sodium polystyrene sulfonate (SPS) and sevelamer carbonate, to further reduce the potassium and phosphorus content of formula, respectively. Unfortunately, pretreating formulas also reduces the levels of other essential nutrients, including calcium and magnesium [3–6]. It is important for clinicians prescribing such formulas to be aware of which essential nutrients can be altered in order to avoid the iatrogenic effects of the pretreated formula, especially since infants and children with kidney disease are already at high risk of malnutrition and growth impairment [7].…”

“…A variety of formulas, treatment times, and medication doses have been tested; however, no single, standardized pretreatment method has been determined best for clinical practice [3–6, 8–12]. Published studies have also examined a limited number of nutrients [3–6, 8–12].…”

“…Published studies have also examined a limited number of nutrients [3–6, 8–12]. The goal of this study was to evaluate the effects of controlled treatment times, medication doses, and co-administration of medications in renal-specific formulas on a broader range of essential and nonessential minerals and formula pH.…”

Nutrition Management in Childhood Kidney Disease: an Integrative and Lifecourse Approach

“…Calcium carbonate can be mixed with daytime and nighttime feeds. However, in infants with hypercalcemia, the newly available sevelamer (Renvela ® ) powder can be used as an alternative [18]. Renvela ® is first reconstituted in water and then mixed with the overnight feeds.…”