NDT Advance Access originally published online on June 1, 2005
Nephrology Dialysis Transplantation 2005 20(8):1653-1661; doi:10.1093/ndt/gfh894
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Two year comparison of sevelamer and calcium carbonate effects on cardiovascular calcification and bone density
1 KfH Nierenzentrum Sonnenallee Berlin, Berlin, 2 KfH Nierenzentrum Nürnberg, Nürnberg, 3 KfH Nierenzentrum Moabit Berlin, Berlin, 4 KfH Nierenzentrum Hannover, Klinikum Hannover Oststadt, Podbielskistrasse 380, D-30659 Hannover, 6 Klinikum Bamberg, Bamberg, 7 Universitätsklinikum Charité, Berlin, 9 Universitätsklinikum Heidelberg, Sektion Nephrologie, Bergheimerstrasse 56a, D-69115 Heidelberg, Germany, 5 Universitätskinikum Graz, Graz, Austria and 8 Tulane University School of Medicine, New Orleans, LA, USA
Correspondence and offprint requests to: Professor Jürgen Bommer, Klinikum der Universität Heidelberg, Sektion Nephrologie, Bergheimerstrasse 56a, D-69115 Heidelberg, Germany. Email: juergen_bommer{at}t-online.de
Background. Calcium-based phosphate binders may induce tissue calcification, and little is known about their effects on bone density. We compared the effects of a calcium with a non-calcium phosphate binder on both arterial calcification and bone density measured by computed tomography.
Methods. Seventy-two adult haemodialysis patients were randomized to treatment with calcium carbonate (CC) or sevelamer (SEV) for 2 years. Electron beam CT scans were performed at baseline and at 6, 12 and 24 months. Serum phosphorus, calcium, calcium xphosphorus product and intact parathyroid hormone (iPTH) were measured and other routine laboratory tests were also carried out.
Results. The average calcium x phosphorus product was similar in the two treatment groups. However, patients receiving CC had significantly lower average iPTH (P<0.01), were more likely to have hypercalcaemic episodes (P = 0.03) and had significantly greater increases in coronary artery (CC median 484, P<0.0001, SEV median 37, P = 0.3118, between-group P = 0.0178) and aortic (CC median 610, P = 0.0003, SEV median 0, P = 0.5966, between-group P = 0.0039) calcification scores. The CC group also had a significant decrease in trabecular bone density (CC median –6%, P = 0.0049, SEV median +3%, P = 0.0296, between-group P = 0.0025). However, there was no significant difference in cortical bone density between the two groups.
Conclusions. This 2 year study shows that calcium carbonate use is continuously associated with progressive arterial calcification in haemodialysis patients. In addition, it suggests that it is also associated with decreased trabecular bone density. However, this latter finding requires confirmation by a study specifically devoted to this issue.
Keywords: bone; calcium; hyperphosphataemia; hyperparathyroidism; phosphate; sevelamer
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