Effect of Sevelamer on Bone Profile in High Flux Regular Haemodialysis Patients

Abstract

Elevated serum phosphate levels (hyperphosphataemia) are an unavoidable clinical consequence of the advanced stages of CKD. Hyperphosphataemia is linked with a number of serious clinical complications, including vascular calcification and left ventricular hypertrophy, as well as increased all-cause and cardiovascular (CV) mortality. Hyperphosphatemia is accompanied by hypocalcemia and low serum levels of vitamin D. Without treatment, these deficiencies usually lead to severe secondary hyperparathyroidism, which in turn leads to painful fractures and generalized osteopenia. Dietary restriction of phosphate has long been the cornerstone of therapy, but this measure is usually not sufficient to control hyperphosphatemia. As a result, oral phosphate binders are used in over 90% of patients with kidney failure, The ideal phosphate binder would avidly bind dietary phosphate, have minimal systemic absorption, have few side effects, have a low pill burden, and be inexpensive. Unfortunately, none of the currently available oral phosphate binders meet all these criteria. Sevelamer is an anion-exchange resin, first released as sevelamer hydrochloride, is currently approved by the Food and Drug Administration and marketed as sevelamer carbonate, which appears to have a similar effect on phosphate lowering but has been much less extensively studied. In order to study the effect of high flux dialyser use and ‎sevelamer administration on routine laboratory ‎investigations in patients on regular haemodialysis, this ‎study was conducted on 60 patients with End Stage Renal ‎Disease on regular haemodialysis. Patients were divided into ‎‎2 groups: Group A included 30 patients with End stage renal ‎disease on regular haemodialysis will be subjected to high ‎flux polysulfondialyser membrane, four hours per session ‎three times/week for three months. Group B included 30 ‎patients with End stage renal disease on regular ‎haemodialysis with high flux polysulfondialyser membrane ‎and sevelamer administration (oral sevelamer‎administration 800mg three times/day for three months).‎ On comparison of Phosphorus After treatment among ‎studied groups, it was lower in group A, with highly ‎significant statistical difference, while on comparison of every group individually, it was higher before treatment, with highly significant ‎statistical difference.‎ Regarding parathromoneafter treatment among studied ‎groups, it was lower in group A, with highly significant ‎statistical difference.‎