Use of sevelamer in chronic kidney disease: beyond phosphorus control

Rodríguez-Osorio, Laura; Zambrano, Diana Pazmiño; Gracia-Iguacel, Carolina; Rojas-Rivera, Jorge; Ortíz, Alberto; Egido, Jesús; Parra, Emilio González

doi:10.1016/j.nefroe.2015.05.011

Cited by 10 publications

(10 citation statements)

References 88 publications

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“…Sevelamer (hydrochloride or carbonate), a polyphosphate binder, is noted for its ability to bind uremic toxins. Although some experiments and/or clinical studies report beneficial effects on reducing uremic toxins, such as serum IS and pCS levels, the results of the clinical studies published to date are conflicting [83].…”

Section: Adsorption Therapymentioning

confidence: 99%

The clinical impact of gut microbiota in chronic kidney disease

Kim

Song

2020

Korean J Intern Med

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Gut microorganisms play critical roles in both maintaining host homeostasis and the development of diverse diseases. Gut dysbiosis, an alteration of the composition and function of gut microorganisms, is commonly seen in patients with chronic kidney disease (CKD). CKD itself contributes to a disruption of the symbiotic relationship between the gut microbiota and the host, while the resulting gut dysbiosis may play a part in stage progression of CKD. This bidirectional relationship supports the concept that the gut microbiota is considered a novel focus for the pathogenesis and management of CKD. This article examines the interaction between the gut microbiota and the kidney, the mutual effects of dysbiosis and CKD, and possible treatment options to restore gut eubiosis, and reduce CKD progression and its related complications.

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Section: Adsorption Therapymentioning

confidence: 99%

The clinical impact of gut microbiota in chronic kidney disease

Kim

Song

2020

Korean J Intern Med

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“…Along with this approved indication, many studies have shown that sevelamer has pleiotropic effects in reducing endothelial damage, serum lipid levels, inflammatory endotoxins and glycated haemoglobin (HbA1C) in patients with CKD. [6][7][8][9][10] Several studies have shown that sevelamer significantly reduces the serum lipid levels (low-density lipoprotein (LDL) and total cholesterol (TC)) in patients with CKD. [11][12][13][14][15][16][17][18][19] The mechanism by which sevelamer exerts this action is by bile acid sequestration that leads to increased excretion of bile acids in faeces.…”

Section: Introductionmentioning

confidence: 99%

“…In 1998; sevelamer was approved by Food and Drug Administration (FDA) for the control of serum phosphorus in CKD patients. Along with this approved indication, many studies have shown that sevelamer has pleiotropic effects in reducing endothelial damage, serum lipid levels, inflammatory endotoxins and glycated haemoglobin (HbA1C) in patients with CKD 6–10 …”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta‐analysis of potential pleiotropic effects of sevelamer in chronic kidney disease: Beyond phosphate control

et al. 2021

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Sevelamer, has been shown to have many pleiotropic actions on lipid panel, various inflammatory markers, and blood glucose levels in chronic kidney disease patients.We conducted a systematic review and meta-analysis to compare these pleiotropic effects of sevelamer to other phosphate binders used in chronic kidney disease patients. The relevant randomized controlled trials published from 1 January 2001 to 31 November 2019 on the following databases: Cochrane Central Register of Controlled Trials published in The Cochrane Library, PubMed, Scopus and Google Scholar were identified. All the included studies were independently assessed for eligibility and risk of bias. The modified data extraction form of Cochrane was used. This review included 44 studies for qualitative analysis and 28 reports for quantitative analysis. A meta-analysis of three studies (n = 180) showed that glycated haemoglobin had significantly decreased in sevelamer-treated patients (MD: 0.5%; p = <.001). Compared with calcium-based phosphate binders, sevelamer showed a significant reduction in low-density lipoprotein (MD: À19.43 mg/dL; p = <.001) and total cholesterol (MD: À19.98 mg/dL; p < .001). A significant increase in high-density lipoprotein (MD: 1.29 mg/dL; p = .05) was also prominent in sevelamer treated patients. However, we were not able to observe a significant change in other biochemical parameters such as TG, CRP, hs-CRP, FGF-23, IL-6 and albumin as, no statistically significant difference was observed.

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“…Experimental, observational, and clinical trials have shown sevelamer hydrochloride to have pleiotropic effects beyond the control of hyperphosphatemia. Sevelamer hydrochloride acts on inflammation, OS, lipid profile, atherogenesis, vascular calcification, and endothelial dysfunction, and reduces uremic toxins ( 9 , 10 ). Patients on HD have a high risk of mortality from all causes and cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Sevelamer Hydrochloride and Calcium Carbonate on Markers of Inflammation and Oxidative Stress in Hemodialysis at Six Months of Follow-Up

et al. 2021

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Patients with end-stage renal disease (ESRD) present alterations in mineral and bone metabolism. Hyperphosphatemia in ESRD is considered an independent risk factor for cardiovascular disease (CVD), increasing morbidity, and mortality. Sevelamer hydrochloride is a calcium-free, non-absorbable phosphate-chelating polymer. Calcium carbonate chelator is helpful in controlling serum phosphate levels. There is insufficient information on the influence of sevelamer hydrochloride and calcium carbonate on the behavior of oxidative stress (OS) markers and inflammation in patients on hemodialysis (HD). A randomized open clinical trial was carried out on patients to evaluate sevelamer hydrochloride and calcium carbonate influence at 6 months of study follow-up. Levels of oxidants (LPO, NO, and 8-isoprostanes), antioxidants (SOD and TAC), oxidative DNA damage (8-OHdG and hOGG1), pro-inflammatory cytokines (IL-6 and TNF-α), and inflammation markers (ferritin and C-reactive protein) were measured with colorimetric and ELISA methods. We found a significant increase in oxidants LPO and NO, and antioxidants SOD and TAC, and downregulation of IL-6 and TNF-α. Ferritin decrease at 6 months follow-up in the sevelamer hydrochloride group. Increase in C-reactive protein was found in the group of patients treated with calcium carbonate. In conclusion, we found an oxidative state imbalance with increase in LPO and NO oxidants. The activity of the antioxidant enzymes (SOD and TAC) was also found to increase, suggesting a compensatory effect in the face of increase in oxidants. The same phenomenon was observed with increase in the oxidative damage marker to DNA and the increase in the DNA repair enzyme, suggesting a compensatory effect. Pro-inflammatory cytokines were predominantly downregulated by TNF-α in the group that ingested sevelamer hydrochloride in the final determination at 6 months of follow-up. Serum ferritin levels decreased significantly at the end of follow-up in patients on HD in the sevelamer hydrochloride group. The management of hyperphosphatemia with sevelamer hydrochloride appears to have obvious anti-inflammatory and antioxidant benefits.

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Use of sevelamer in chronic kidney disease: beyond phosphorus control

Cited by 10 publications

References 88 publications

The clinical impact of gut microbiota in chronic kidney disease

The clinical impact of gut microbiota in chronic kidney disease

Systematic review and meta‐analysis of potential pleiotropic effects of sevelamer in chronic kidney disease: Beyond phosphate control

The Influence of Sevelamer Hydrochloride and Calcium Carbonate on Markers of Inflammation and Oxidative Stress in Hemodialysis at Six Months of Follow-Up

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