Category Archives: Phosphate Binders
Sevelamer Versus Calcium Carbonate in Incident Hemodialysis Patients: Results of an Open-Label 24-Month Randomized Clinical Trial
Hemodialysis.com eInterview with:
Dr. Antonio Bellasi
UOC Nefrologia e Dialisi
Azienda Ospedaliera S.Anna (CO), Via Ravona,
22020 San Fermo della Battaglia (Como), Italy
and Dr. Biagio Raffaele Di Iorio
Università degli Studi di Napoli Federico II
Hemodialysis.com: What are the main findings of the study?
Response: The main findings are that non-calcium containing phosphate binder maybe superior than calcium containing phosphate binder in CKD-5D dialysis patients. Current results expand the existing body of evidence, confirming what reported by Block et al in a secondary analysis of the RIND study (Block et al Kidney Int 2007; 71(5):438-41) and suggesting the survival benefit is mainly driven by the different impact of these 2 phosphate binder regimens on the cardiovascular system.
Indeed, we did not observe any non-CV survival difference between groups.
Finally, numerous studies suggest now that calcium supplementation maybe associated with a significant increase in the CV risk in post-menopausal women further questioning the excessive use of calcium (Bolland et al Br Med J 2010; 341:C3691).
Marie Benz, MD on Google+Evaluation of colestilan in chronic kidney disease dialysis patients with hyperphosphataemia and dyslipidaemia: a randomized, placebo-controlled, multiple fixed-dose tria
Hemodialysis.com eInterview with
Prof. Francesco Locatelli, MD, FRCP
Department of Nephrology and Dialysis, Ospedale A. Manzoni
Via Dell’Eremo 9–11
IT–23900 Lecco (Italy)
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Prof. Locatelli: This global 642 patient study assessed the effect of a range of doses of the new, non-metallic phosphate binder, colestilan, in reducing simultaneously both serum phosphorus and LDL-cholesterol levels in patients with chronic kidney disease stage 5 on dialysis who have both hyperphosphataemia and dyslipidaemia. In this 12 week, double-blind trial, which is probably the largest dual-endpoint study done in this area, we showed that colestilan significantly lowered both serum phosphorus and LDL-cholesterol, over a range of doses, while not influencing calcium levels and is generally well tolerated. Colestilan also was shown to reduce total cholesterol, oxidised LDL-cholesterol, high HbA1c levels and uric acid.
Cost implications of switching from sevelamer to lanthanum carbonate within a bundled reimbursement scenario
Interview with Dr. Michael S Keith Shire Pharmaceuticals, Wayne, PA, USA
Hemodialysis.com: What are the main findings of the study?
Dr. Keith: The key finding from this post hoc analysis is that phosphate control was similar regardless of the prior sevelamer dose a patient received. Overall mean phosphate binder doses were SH 7703 mg/day and LC 2800 mg/day. Drug cost-savings were realized when applying clinically utilized doses of lanthanum carbonate (LC) 3000 mg/day ($26.46/day) and sevelamer hydrochloride (SH) from doses of 6400 mg/day ($29.68/day) and above. Cost savings were as high as $18/day when converting patients from SH 9600 mg/day to LC 3000 mg/day.
Importance of Understanding Phosphate Binding Capacity of Sevelamer and Lanthanum in Relation to Dietary Protein and Phosphate Intake in Chronic Hemodialysis Patients
Hemodialysis.com Interview with: William F. Finn, MD
Professor of Medicine (Ret)
University of North Carolina
School of Medicine
Hemodialysis.com: What are the main findings of the study?
Dr. Finn: Published reports were examined that detailed changes in the urinary excretion of phosphorus that followed the administration of various doses of either sevelamer hydrochloride/carbonate (SHC) or lanthanum carbonate (LC).
From these data, dose-response curves were developed.
These data demonstrated that the relative binding capacity of each agent decreased as doses was increased. That is, the respective dose-response curves are non-linear. At the upper limits of the clinically recommended doses, the phosphorus binding capacities plateau. This has important implications for the management of hyperphosphatemia in dialysis patients for it places an upper limit on the amount of phosphorus that can be bound. On the basis of these dose-response curves, it would require 18.4 g of SHC or 4.6 g of LC to bind 350 mg of phosphorus. This helps to explain the persistent hyperphosphatemia among many patients whose required dietary protein intake exceeds the ability to maintain phosphorus intake at or below 1000 mg per day.
The Dose-Relativity of Sevelamer to Lanthanum under Real-World Conditions: Implications for Patient Management
Hemodialysis.com Author Interview: J Brian Copley, MD FASN FACP
Hemodialysis.com: What are the main findings of the study?
Dr. Copley: Dose relativity, with respect to the various phosphate binders, refers to the comparative dosage of phosphate binder required to achieve similar levels of phosphorus control.
This is a post hoc analysis of a post marketing, phase IV study of patients with ESRD and hyperphosphatemia in a real-world clinical practice setting in the US.
