Cardiovascular mortality in chronic kidney disease patients: potential mechanisms and possibilities of inhibition by resin-based phosphate binders

  title={Cardiovascular mortality in chronic kidney disease patients: potential mechanisms and possibilities of inhibition by resin-based phosphate binders},
  author={Francesco Locatelli and Lucia Del Vecchio},
  journal={Expert Review of Cardiovascular Therapy},
  pages={489 - 499}
Cardiovascular mortality has been considered as the most important risk associated with chronic kidney disease. The mechanisms underlying this include inflammation, poor control of serum phosphate, high serum calcium, increased calcification of the arteries and cardiac valves, hyperlipidemia, diabetes, severe anemia, uric acid accumulation and others. Elevated phosphate levels have been strongly associated with increased mortality, thus phosphate-binding drugs have long been used to control the… 

Management of Chronic Kidney Disease-Mineral Bone Disorder with Sevelamer Hcl Phosphate Binder in Korean Patients with Dialysis

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Plasma p-cresol lowering effect of sevelamer in non-dialysis CKD patients: evidence from a randomized controlled trial

This study represents the first evidence that SEV is effective in reducing p-cresol levels in CKD patients in conservative treatment, and confirms its beneficial effects on inflammation and lipid pattern.

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Using nanofiltration membranes for the recovery of phosphorous with a second type of technology for the Recovery of nitrogen is suggest to be a viable process.



Oral phosphate binders in CKD - is calcium the (only) answer?

Evidence shows that most phosphate binders are roughly equally effective in lowering serum phosphate concentrations in adults compared to placebo, with a small probability that sevelamer hydrochloride is better than calcium acetate or lanthanum carbonate.

The case against calcium-based phosphate binders.

  • S. MoeG. Chertow
  • Medicine
    Clinical journal of the American Society of Nephrology : CJASN
  • 2006
Calcium-based phosphate binders should be avoided in many, if not most, patients who are undergoing dialysis, because of the compelling biologic plausibility that hyperphosphatemia and excess exogenous calcium administration can accelerate vascular calcification.

Are there ways to attenuate arterial calcification and improve cardiovascular outcomes in chronic kidney disease?

Current available treatment options include non-calcium containing phosphate binders, low dose active vitamin D, calcimimetic agent and perhaps bisphosphonates, vitamin K and sodium thiosulfate but larger studies on efficacy and outcomes are needed.

Association of serum phosphate with vascular and valvular calcification in moderate CKD.

Higher serum phosphate concentrations are associated with a greater prevalence of vascular and valvular calcification in people with moderate CKD, and it remains to be determined whether lowering phosphate concentrations will impact calcification risk in the setting of kidney disease.

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  • A. Rastogi
  • Medicine, Biology
    Therapeutic advances in cardiovascular disease
  • 2013
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Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients.

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Effects of sevelamer and calcium-based phosphate binders on uric acid concentrations in patients undergoing hemodialysis: a randomized clinical trial.

Treatment with sevelamer was associated with a significant reduction in serum uric acid concentrations in an international, multicenter, clinical trial compared with calcium-based phosphate binders.

Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study.

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The progression of coronary artery calcification in predialysis patients on calcium carbonate or sevelamer.

The study shows that sevelamer treatment should not be restricted to dialysis patients; however, a larger study should be undertaken to confirm these results.