ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO2503

Sevelamer-Associated Gastrointestinal Complications in Kidney Transplant Recipients

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Hussain, Mohammad Ahraz, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Kwong, Stanley, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Yabu, Julie M., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Lum, Erik Lawrence, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Kendrick, Elizabeth A., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
Introduction

Sevelamer (SV) is a resin based oral phosphate binder used commonly in chronic kidney disease (CKD) patients. Clinical trials performed for approval for clinical use showed mild to moderate gastrointestinal (GI) intolerance in a minority of patients. In general clinical use of SV in CKD patients, there have been case reports of more serious GI problems than were reported in original trials, including GI bleeding and colonic complications including colitis and perforation. The majority of patients receiving kidney transplants have required long term oral phosphate binders at the time they are transplanted, often using SV. Delayed graft function (DGF) early post transplant may require ongoing use of oral phosphate binders to control hyperphosphatemia

Case Description

We report 3 cases of significant GI morbidity in association with SV occurring in transplant recipients within the first 2 weeks after kidney transplantation. In one patient, the post transplant course was complicated by sepsis due to perforated colonic diverticulum in the context of preexisting diverticular disease; surgical specimen showed SV crystals associated within the area of bowel perforation. Two patients had severe upper GI symptoms and abnormal findings on upper endoscopy, including severe esophagitis and esophageal ulceration. SV crystals were found in the biopsies of abnormal areas. Two patients had long-term use of SV prior to transplantation, whereas one patient was treated with SV for a short time only after transplantation. All had required more than one phosphate binder for long-term control of hyperphosphatemia; two required cinacalcet for management of secondary hyperparathyroidism.

Discussion

SV use may have more serious GI adverse effects in CKD patients than noted in the original clinical trials. Preexisting GI disease and/or abnormalities may increase the risk of adverse GI effects related to SV. Recent use of SV prior to kidney transplantation or use of SV for control of hyperphosphatemia in the context of DGF can be associated with GI morbidity in the early post transplant setting. Need for higher doses of phosphate binders and severity of hyperparathyroidism may be contributing factors to this risk.