Document Detail

Evaluation of morbidity and mortality data related to cardiovascular calcification from calcium-containing phosphate binder use in patients undergoing hemodialysis.
MedLine Citation:
PMID:  20575637     Owner:  NLM     Status:  MEDLINE    
Cardiovascular disease is the leading cause of death among patients with stage 5 chronic kidney disease. Several mechanisms are thought to contribute to vascular calcification and subsequent cardiovascular disease in patients who require hemodialysis. One of these mechanisms is the use of calcium-containing phosphate binders to treat hyperphosphatemia. Although most phosphate binding occurs in the gastrointestinal tract, some calcium is inevitably absorbed and has the potential to perpetuate the calcium-phosphorus product and the development of vascular and soft tissue calcification. Some phosphate binders such as sevelamer hydrochloride do not contain calcium and therefore may not carry the same risks. We examined the cardiovascular calcification effect and morbidity and mortality data with calcium-containing phosphate binders compared with sevelamer hydrochloride when given to patients with stage 5 chronic kidney disease for the treatment of hyperphosphatemia. A literature search using the MEDLINE and PubMed databases identified relevant articles from 1989-2009; nine studies compared vascular calcification between a calcium-containing phosphate binder and sevelamer hydrochloride. Three mortality studies were also identified. Seven of the nine studies reported a statistically significant increase in vascular calcification in patients taking calcium-containing phosphate binders as measured by coronary artery calcification scores and aortic calcification scores. In two trials, lower mortality rates were observed in the patients receiving sevelamer hydrochloride compared with calcium-containing phosphate binders. No significant difference in the mortality rate was observed in the third trial. Based on the current literature, it appears that calcium-containing phosphate binders promote the progression of vascular calcification to a greater extent than does sevelamer hydrochloride. In addition, some evidence suggests that sevelamer hydrochloride may reduce all-cause mortality rates in patients undergoing hemodialysis, particularly those aged 65 years or older. Thus, although sevelamer hydrochloride appears to be the more appropriate choice of phosphate binder for patients undergoing hemodialysis in whom cardiovascular calcification is a concern, more clinical trials are needed to further guide practitioners on the selection of phosphate binders.
Molly A Mason; Brian M Shepler
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Pharmacotherapy     Volume:  30     ISSN:  1875-9114     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-25     Completed Date:  2010-10-04     Revised Date:  2013-04-05    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  741-8     Citation Subset:  IM    
School of Pharmacy and Pharmaceutical Sciences, Purdue University, West Lafayette, Indiana 47907-2091, USA.
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MeSH Terms
Calcinosis / complications,  drug therapy,  etiology*
Calcium / therapeutic use
Calcium Phosphates / therapeutic use
Calcium, Dietary / therapeutic use
Cardiovascular Diseases / drug therapy,  etiology
Clinical Trials as Topic / adverse effects
Coronary Artery Disease / complications,  drug therapy,  etiology
Disease Progression
Phosphates / therapeutic use
Renal Dialysis / adverse effects*
Reg. No./Substance:
0/Calcium Phosphates; 0/Calcium, Dietary; 0/Phosphates; 0/Polyamines; 182683-00-7/sevelamer; 7440-70-2/Calcium; 97Z1WI3NDX/calcium phosphate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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