1. Phosphate Binder Impact on Bone Remodeling and Coronary Calcification – Results from the BRiC Study
- Author
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Vanda Jorgetti, Fellype C. Barreto, Aluizio B. Carvalho, Rosa M.A. Moysés, Marcio H. Miname, Lilian Cuppari, Sergio Antonio Draibe, Maria Eugênia Fernandes Canziani, Daniela V. Barreto, Maria Aparecida Dalboni, Katia R. Neves, and Raul D. Santos
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Sevelamer ,Comorbidity ,Coronary Artery Disease ,Acetates ,Bone remodeling ,chemistry.chemical_compound ,Renal Dialysis ,Internal medicine ,Polyamines ,Humans ,Medicine ,Renal osteodystrophy ,Chelating Agents ,business.industry ,Incidence ,Calcinosis ,General Medicine ,Calcium Compounds ,Middle Aged ,medicine.disease ,Phosphate ,Phosphate binder ,Treatment Outcome ,Endocrinology ,chemistry ,Nephrology ,Circulatory system ,Female ,Bone Remodeling ,Hemodialysis ,business ,Brazil ,Calcification ,medicine.drug - Abstract
Backgroundand Aims: Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients. This is a prospective study that compares the effects of calcium acetate and sevelamer on coronary calcification (CAC) and bone histology. Methods: 101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice coronary tomographies and bone biopsies at entry and 12 months. Results: The 71 patients who concluded the study had similar baseline characteristics. On follow-up, the sevelamer group had higher levels of intact parathyroid hormone (498 ± 352 vs. 326 ± 236 pg/ml, p = 0.017), bone alkaline phosphatase (38 ± 24 vs. 28 ± 15 U/l, p = 0.03) and deoxypyridinoline (135 ± 107 vs. 89 ± 71 nmol/l, p = 0.03) and lower LDL cholesterol (74 ± 21 vs. 91 ± 28 mg/dl, p = 0.015). Phosphorus (5.8 ± 1.0 vs. 6 ± 1.0 mg/dl, p = 0.47) and calcium (1.27 ± 0.07 vs. 1.23 ± 0.08 mmol/l, p = 0.68) levels did not differ between groups. CAC progression (35 vs. 24%, p = 0.94) and bone histological diagnosis at baseline and 12 months were similar in both groups. Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption (eroded surface, ES/BS = 9.0 ± 5.9 vs. 13.1 ± 9.5%, p = 0.05), whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate (BFR/BS = 0.015 ± 0.016 vs. 0.062 ± 0.078, p = 0.003 for calcium and 0.017 ± 0.016 vs. 0.071 ± 0.084 μm3/μm2/day, p = 0.010 for sevelamer). Conclusions: There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups.
- Published
- 2008
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