Abstract
In individuals with chronic kidney disease (CKD), including those undergoing maintenance hemodialysis (MHD), coronary artery calcification (CAC) is common. We hypothesized that, in MHD patients, intake of the calcium-free phosphate binder sevelamer is associated with lower CAC compared to calcium-based phosphate binders (CBPB). This is a cross-sectional study of MHD patients, who underwent computerized tomography to assess coronary artery calcium scores (CACS). Patients were stratified into two mutually exclusive groups based on taking only a CBPB vs. sevelamer. Logistic regression was used to calculate adjusted odds ratio (OR) of CACS > or = 400, CACS 100 < or =; CACS < 400, 10 < or =; CACS < 100 vs. CACS < 10. 117 MHD patients were either on a CBPB alone (n = 60) or sevelamer alone (n = 57). Despite increased prevalence of DM in the sevelamer group (58%) as compared to the CBPB group (35%), CACS was significantly lower with sevelamer use (283 + or - 83 vs. 494 + or - 94, p = 0.02). The OR of significant CACS > or =; 400 vs. CAC < 10 was 4.35 (95% confidence interval: 1.5 - 9.9, p = 0.008) for CBPB compared with sevelamer, after controlling for case-mix, cholesterol-lowering medication, DM, and inflammatory markers. In our cohort, significant CAC was significantly more prevalent among MHD patients taking CBPB as compared to sevelamer monotherapy.
Highlights
More than 400,000 Americans suffer from chronic kidney disease (CKD) Stage 5, known as end stage renal disease (ESRD), and require maintenance hemodialysis (MHD) [1].Almost half of these individuals have developed CKD as a complication of diabetes mellitus (DM) [2]
We studied a sub-group of MHD patients from the “Nutritional and Inflammatory Evaluation of Dialysis Patients” (NIED) study [20] who underwent electron beam computerized tomography (EBCT) and were taking either only a calcium-based phosphate binder (CBPB) or the calcium-free phosphate binder sevelamer hydrochloride (Renagelä, Genzyme, Boston, MA, USA)
DM was 1.6 times more prevalent among the sevelamer group than the calcium-based phosphate binders (CBPB) (58% vs. 35%, p = 0.01), and the baseline serum calcium and calcium phosphorus product (C P) levels were lower in the CBPB group than the sevelamer group (p = 0.0001 and p = 0.001, respectively), the calcium scores (CACS) was significantly lower in the sevelamer group compared to the CBPB group (p = 0.02)
Summary
More than 400,000 Americans suffer from chronic kidney disease (CKD) Stage 5, known as end stage renal disease (ESRD), and require maintenance hemodialysis (MHD) [1]. Almost half of these individuals have developed CKD as a complication of diabetes mellitus (DM) [2]. The all-cause and cardiovascular (CV) mortality in this population is as high as 10- to 30-fold that of the general population even after accounting for age, race, gender, and presence of DM [5, 6]. With the exception of DM, most other conventional CV risk factors fail to explain the high burden of CVD and mortality in the MHD population, even though some factors such as hypertension and obesity are quite common among these patients [7]
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