Effects of Sevelamer Carbonate versus Calcium Acetate on Vascular
Calcification, Inflammation, and Endothelial Dysfunction in Chronic
Rationale & Objective: Hyperphosphatemia is present in most patients
with end-stage renal disease (ESRD) and has been associated with
increased cardiovascular mortality. Phosphate binders (calcium-based and
calcium free) are the mainstay pharmacologic treatment to lower
phosphorus levels in patients with ESRD. Study Design: We evaluated
biochemical markers of vascular calcification, inflammation, and
endothelial dysfunction in patients with Chronic Kidney Disease (CKD)
treated with sevelamer carbonate versus calcium acetate. Setting &
Participants: We enrolled 50 CKD patients (stages 3 and 4) and treated
them with sevelamer carbonate and calcium acetate for 12 weeks.
Outcomes: At the end of the study the biomarkers of vascular
calcification, inflammation, and endothelial dysfunction were analyzed.
Results: A significant increase in HDL-cholesterol was observed with
sevelamer carbonate but not with calcium acetate. Treatment with
sevelamer carbonate reduced serum phosphate, calcium phosphate, and
FGF-23 levels and there was no change with calcium acetate treatment.
The inflammatory markers IL-8, IFN-γ, and TNFα decreased with response
to both treatments. The levels of IL-6 significantly increased with
calcium acetate treatment and no change was observed in the sevelamer
carbonate treatment group. Conclusion: Sevelamer carbonate showed
favorable effects on anti-inflammatory and vascular calcification
biomarkers compared to calcium acetate treatment. Funding: Funding was
received from Sanofi/Genzyme. Trial Registration: Registered at
trial.com, registration number NCT01277497.