Sevelamer-associated gastric erosions in a hemodialysis patient: A case report and brief literature review

Abstract

Introduction: The use of sevelamer as a phosphate binder in chronic kidney disease patients with hyperphosphatemia is typically associated with mild gastrointestinal adverse events. However, recent reports indicate that its effect may be considerably more damaging. Case Report: We describe the incidental finding of sevelamer crystals in the gastric mucosa of a 55-year-old female patient on maintenance hemodialysis. The patient was subjected to gastroscopy as part of anemia investigation which revealed mild gastritis and presence of linear mucosal erosions at the pyloric antrum. Pathology reported extended granulomatous foreign body response in the gastric mucosa. Giant cell histiocytes were identified containing crystalline material with irregularly shaped fish scales. Pathology findings were consistent with lesions described in recent literature as induced by sevelamer crystals. Sevelamer administration was immediately stopped and a follow-up gastroscopy after 12 months showed improvement of the lesions. Conclusion: A thorough literature review reveals that sevelamer-associated mucosal injury has been identified as the underlying cause of several acute gastrointestinal events as well as chronic persistent symptomatology. Currently, its prevalence in hemodialysis patients is largely unknown due to lack of routine endoscopic assessment, however it may be significantly higher than expected. Therefore, timely diagnosis and appropriate management of sevelamer-associated injury require a high index of clinical suspicion, especially for patients with a history of long-term sevelamer use.