Abstract: TH-PO434
Protein-Bound Uremic Toxins Lowering Effect of Sevelamer in Pre-Dialysis CKD Patients with Hyperphosphatemia: A Randomized Controlled Trial
Session Information
- CKD: Clinical, Outcomes, Trials - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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
| Variable | Calcium carbonate | Sevelamer | ||
| Baseline | Week 12 | Baseline | Week 12 | |
| Primary outcome | ||||
| Log plasma p-cresol | 0.80±0.36 | 0.65±0.72 | 1.14±0.24 | 0.83±0.32* |
| Secondary outcomes | ||||
| Plasma high sensitivity-C reactive protein (mg/L) | 1.64±1.58 | 1.84±2.14 | 1.84±2.22 | 1.04±1.72* |
| Serum low density lipoprotein cholesterol (mg/dL) | 95.80±41.99 | 83.50±40.49 | 94.6±30.61 | 60.00±30.63* |
| Serum Calcium (mg/dL) | 8.83±0.89 | 9.09±0.89 | 9.09±0.65 | 9.28±0.66 |
| Serum Phosphate (mg/dL) | 5.36±0.65 | 5.04±0.64 | 5.59±1.00 | 5.07±1.07* |
| estimated glomerular filtration rate (ml/min/1.73m2) | 18.35±6.45 | 15.04±5.42* | 16.23±6.76 | 15.64±5.40** |
* p<0.05 vs baseline,** p<0.05 difference between group
Funding
- Private Foundation Support