Efecto hipolipemiante y antiinflamatorio del sevelamer en pacientes en diálisis peritoneal

Abstract

Background Sevelamer hydrochloride is a non-absorbable, aluminium-and calcium-free ion-exchange resin with proven efficacy and safety in hemodialysis patients. However, until now, little information has been available on the efficacy and safety of this molecule in peritoneal dialysis patients. Patients and method We analyzed the effects of sevelamer hydrochloride through a cross-sectional study of 228 patients under peritoneal dialysis in 10 dialysis units in Catalonia and the Balearic Islands (Spain). Results At the time of the study, 56 % patients were receiving sevelamer. Patients receiving sevelamer were younger (p < 0.01), had been under dialysis for longer (p < 0.01) and had a lower Charlson comorbidity index (p < 0.01) than patients not receiving this drug. Serum calcium levels and intact parathyroid hormone (i-PTH) levels showed no differences between the 2 groups, while sevelamer-treated patients and higher levels of serum phosphate and calcium-phosphate product. Phosphate levels < 5.5 mg/dl were observed less frequently in patients receiving sevelamer (61 % vs. 79 %; p < 0.01). Total serum cholesterol (167 ± 41 vs. 189 ± 42 mg/dl; p < 0.0001) and low-density lipoprotein cholesterol (90 ± 34 vs. 109 ± 34 mg/dl; p < 0.0003) levels were lower in sevelamer-treated patients. Moreover, sevelamer-treated patients displayed higher serum albumin (38 ± 5 vs. 36 ± 4 g/l; p < 0.01) and lower C reactive protein (4.9 ± 12.8 vs. 8.8 ± 15.7 mg/l; p < 0.01) levels, revealing better nutritional and inflammatory status. Blood bicarbonate levels were lower in patients receiving sevelamer (24 ± 3.2 vs. 26.7 ± 3.2 mmol/l; p < 0.01). Conclusions Sevelamer hydrochloride treatment may have an anti-inflammatory effect in addition to improving lipid profile and achieving good phosphate levels, similar to those achieved in patients under hemodialysis. We recommend close monitoring of bicarbonate levels in this group of patients.