Sevelamer improves survival in HD patients
For patients on maintenance hemodialysis, the use of sevelamer as an add-on or alternative therapy to calcium-based phosphate binders is associated with improved survival.
This is the result of the present study conducted by researchers at the University of Michigan in Ann Arbor and the Tokai University School of Medicine in Japan (Komaba H et al, Initiation of Sevelamer and Mortality among Hemodialysis Patients Treated with Calcium-Based Phosphate Binders; Clin J Am Soc Nephrol. 2017 Sep 7;12(9):1489-1497). The findings confirm prior studies that had already shown that sevelamer could attenuate the progression of arterial calcification and possibly even reduce the risk of death compared with calcium-based phosphate binders. However, as the authors point out, in clinical practice sevelamer is used not only as an alternative, but also as an add-on therapy in patients that are already being treated with calcium-based phosphate binders. Hence, they evaluated sevelamer both as an add-on as well as an alternative therapy to calcium-based phosphate binders.
The study is based on the data of 12,500 patients of the “Dialysis Outcomes and Practice Patterns Study” (DOPPS), who were prescribed calcium-based phosphate binders at baseline or before sevelamer treatment. Around 2,600 of these patients were subsequently treated with sevelamer hydrochloride or sevelamer carbonate. After initiation of the sevelamer therapy, the mean serum phosphorus levels decreased by 0.3 mg/dl in the first four months and gradually decreased thereafter. A further finding: Patients treated with sevelamer had a 14 percent lower risk for mortality compared with as-yet-untreated patients (hazard ratio, 0.86; 95% confidence interval, 0.76 to 0.97).
Sevelamer as an add-on or alternative therapy to calcium-based phosphate binders is associated with improved survival in patients on maintenance hemodialysis, conclude the authors.
Link to the study: http://cjasn.asnjournals.org/content/12/9/1489.abstract