#3930 EFFECT OF TWO PHOSPHATE BINDERS ON VITAMIN D LEVELS IN HEMODIALYSIS PATIENTS

Abstract

Abstract Background and Aims A recent meta-analysis highlighted the impact of different types of phosphate binders on vitamin D metabolism in patients with stage 3 CKD. Sevelamer was associated with lower serum 25(OH) vitamin D levels probably due to reduced intestinal absorption of D3 (cholecalciferol). Corresponding effects of different phosphate binders in hemodialysis patients have not been studied. Method We performed an observational prospective study in which 55 stable hemodialysis patients were followed for 28 months. Patients’ age was 42-91 years old and duration of hemodialysis was 2-312 months. Patients received as phosphate binders sevelamer, sucroferric oxyhydroxide or combination. The type of binders, the administration of D3 supplements, paricalcitol or etecalcetide as well as the biochemical control of the patients were recorded every two months. Serum 25(OH) vitamin D levels and the proportion of patients who required D3 supplementation to maintain 25(OH) vitamin D levels >20ng/mL were assessed. Results At baseline, 60% of patients used sevelamer as phosphate binder, 22% sucroferric oxyhydroxide and 18% combination, while 36% were on D3 supplements. Levels of 25(OH) vitamin D showed a significant increase after the first year of follow-up. (Dstart:16±8ng/ml vs D12months:26±10ng/ml, P = .001). After one year D3 supplementation ratio increased to 48% and remained at these levels until the end of follow-up. Taking paricalcitol or etecalcetide did not affect the results. No differences in 25(OH) vitamin D and D3 supplementation rate levels were observed between those receiving the different binders or the co administration group. No differences were observed in the biochemical markers tested as well as in dialysis adequacy. Conclusion In context of daily clinical practice, no differences were observed in the levels of 25(OH) vitamin D in either patients receiving sevelamer, sucroferric oxyhydroxide or combination of both as phosphate binders. Half of hemodialysis patients require cholecalciferol supplementation to maintain adequate 25(OH)vitamin D levels.