Abstract
Back ground: There are no published clinical data in hemodialysis (HD) patients with mineral bone disorder (CKD-MBD) regarding the effect of sevelamer hydrochloride on the absorption of the oral calcitriol. Objectives: The aim of the present study was to determine the association of the sevelamer hydrochloride and serum 1-25(OH)2D concentration during oral calcitriol therapy. Methods: This was a before-and-after study in HD patients. Forty-six patients co-administered with phosphate-binder and calcitriol for CKD-MBD therapy took lanthanum carbonate (LC) and sevelamer hydrochloride (SH) for 4 weeks, respectively with calcitriol. The serum 1-25(OH)2D concentration was assessed after each period. Results: Serum 1-25(OH)2D concentration was significantly reduced with co-administration of SH compared to LH (mean, calcitriol with LC→SH: 19.9 pg/ml → 14.2 pg/ml, p 2D concentrations after oral calcitriol administration compared to LH in HD patients. When we use SH as a phosphate binder with calcitriol for HD patients with CKD-MBD, we should consider the inhibitory effect of SH on oral calcitriol absorption.
Highlights
Secondary hyperparathyroidism (SHPT) associated with hyperphosphatemia and fibroblast growth factor 23 (FGF-23) are known to play central roles in the pathological state of CKD-MBD [1]
No adverse events or side effects that appeared to be attributable to oral lanthanum carbonate (LC) or sevelamer hydrochloride (SH) were observed during the study period, and all of the subjects completed the entire 8-week study period
The daily dose of calcitriol prescribed, which was constant throughout the study period, was 0.32 ± 0.11 μg
Summary
Secondary hyperparathyroidism (SHPT) associated with hyperphosphatemia and fibroblast growth factor 23 (FGF-23) are known to play central roles in the pathological state of CKD-MBD (chronic kidney disease-mineral and bone disorder) [1]. Hyperphosphatemia is one of risk factors for vascular calcification [2], and associations with cardiovascular complications and shortening of life expectancy have been reported based on epidemiological studies of CKD patients [3] [4]. Calcium-containing phosphate binders have long been used worldwide, but based on the results of recent research there is concern that they may cause low-turnover bone disease and vascular calcification as a result of the calcium load [10], and the calcium-free phosphate binders, sevelamer hydrochloride and lanthanum carbonate, were developed in view of this drawback. Favorable serum-phosphorus-lowering actions [11] [12] and the possibility of an ameliorating effect on the life expectancy of elderly dialysis patients [13] [14] were demonstrated, and one after the other they have been applied clinically in Japan as well as abroad
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