Journal Article

Two year comparison of sevelamer and calcium carbonate effects on cardiovascular calcification and bone density

Hans-Gernot Asmus, Johan Braun, Rolfdieter Krause, Reinhard Brunkhorst, Herwig Holzer, Walter Schulz, Hans-Hellmut Neumayer, Paolo Raggi and Jürgen Bommer

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 20, issue 8, pages 1653-1661
Published in print August 2005 | ISSN: 0931-0509
Published online May 2005 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfh894
Two year comparison of sevelamer and calcium carbonate effects on cardiovascular calcification and bone density

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Background. Calcium-based phosphate binders may induce tissue calcification, and little is known about their effects on bone density. We compared the effects of a calcium with a non-calcium phosphate binder on both arterial calcification and bone density measured by computed tomography.

Methods. Seventy-two adult haemodialysis patients were randomized to treatment with calcium carbonate (CC) or sevelamer (SEV) for 2 years. Electron beam CT scans were performed at baseline and at 6, 12 and 24 months. Serum phosphorus, calcium, calcium ×phosphorus product and intact parathyroid hormone (iPTH) were measured and other routine laboratory tests were also carried out.

Results. The average calcium × phosphorus product was similar in the two treatment groups. However, patients receiving CC had significantly lower average iPTH (P<0.01), were more likely to have hypercalcaemic episodes (P = 0.03) and had significantly greater increases in coronary artery (CC median 484, P<0.0001, SEV median 37, P = 0.3118, between-group P = 0.0178) and aortic (CC median 610, P = 0.0003, SEV median 0, P = 0.5966, between-group P = 0.0039) calcification scores. The CC group also had a significant decrease in trabecular bone density (CC median −6%, P = 0.0049, SEV median +3%, P = 0.0296, between-group P = 0.0025). However, there was no significant difference in cortical bone density between the two groups.

Conclusions. This 2 year study shows that calcium carbonate use is continuously associated with progressive arterial calcification in haemodialysis patients. In addition, it suggests that it is also associated with decreased trabecular bone density. However, this latter finding requires confirmation by a study specifically devoted to this issue.

Keywords: bone; calcium; hyperphosphataemia; hyperparathyroidism; phosphate; sevelamer

Journal Article.  5074 words.  Illustrated.

Subjects: Nephrology

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