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Kidney Week

Abstract: TH-PO434

Protein-Bound Uremic Toxins Lowering Effect of Sevelamer in Pre-Dialysis CKD Patients with Hyperphosphatemia: A Randomized Controlled Trial

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Takkavatakarn, Kullaya, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
  • Puapatanakul, Pongpratch, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
  • Chariyavilaskul, Pajaree, Chulalongkorn University, Bangkok, Thailand
  • Katavetin, Pisut, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
  • Eiam-Ong, Somchai, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
  • Susantitaphong, Paweena, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
Background

P-cresol (pCS), the protein-bound uremic toxins, is strongly associated with cardiovascular events and mortality in chronic kidney disease(CKD). However, effectively therapeutic reduction of this toxin is still limited. This is the first study to evaluate the pleiotropic effects of sevelamer on decreasing of pCS in predialysis CKD patients with hyperphosphatemia.

Methods

This was a randomized controlled trial comparing sevelamer with calcium carbonate in predialysis CKD patients with persistent hyperphosphatemia. After 2 weeks of run-in period, patients were randomly assigned to receive either daily 2,400 mg of sevelamer (n=12) or 3,000 mg of calcium carbonate (n=12) for 12 weeks. Plasma pCS, high sensitivity C-reactive protein (hs-CRP), lipid profiles and renal function were evaluated at baseline and 12 weeks after treatment. The study was registered with the Thai Clinical Trials Registry (TCTR20181018003).

Results

<p style="margin: 0px;">The baseline characteristics were not different. The significant reduction of log plasma pCS, hs-CRP, LDL-cholesterol, and serum phosphate were demonstrated in sevelamer group, whereas non-significant changes were observed in calcium carbonate group (Table1). Interestingly, there was significantly greater renal function progression in calcium carbonate group comparing with sevelamer group (mean difference of eGFR -2.71±1.04 mL/min/1.73m2, p=0.018).</p>

Conclusion

This is the first study to demonstrate benefit effect of sevelamer on decreasing pCS and retarding renal impairment in predialysis CKD patients with hyperphosphatemia. These effects of sevelamer might be considered as treatment for slowing CKD progression and decreasing the risk of cardiovascular events in CKD patients.

Table1
VariableCalcium carbonateSevelamer
BaselineWeek 12BaselineWeek 12
Primary outcome 
Log plasma p-cresol0.80±0.360.65±0.721.14±0.240.83±0.32*
Secondary outcomes 
Plasma high sensitivity-C reactive protein (mg/L)1.64±1.581.84±2.141.84±2.221.04±1.72*
Serum low density lipoprotein cholesterol (mg/dL)95.80±41.9983.50±40.4994.6±30.6160.00±30.63*
Serum Calcium (mg/dL)8.83±0.899.09±0.899.09±0.659.28±0.66
Serum Phosphate (mg/dL)5.36±0.655.04±0.645.59±1.005.07±1.07*
estimated glomerular filtration rate (ml/min/1.73m2)18.35±6.4515.04±5.42*16.23±6.7615.64±5.40**

* p<0.05 vs baseline,** p<0.05 difference between group

Funding

  • Private Foundation Support