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Sevelamer: a promising but unproven drug
1Department of Medicine, University of Otago, Christchurch, New Zealand, 2School of Public Health, University of Sydney and 3Cochrane Renal Group, NHMRC Centre for Clinical Research Excellence in Renal Medicine, The Children's Hospital at Westmead, Westmead, Australia
Correspondence to: Giovanni F. M. Strippoli, MD, Mario Negri Sud Consortium, S. Maria Imbaro (Ch), Italy. Email: strippoli@negrisud.it
Keywords: kidney disease; mineral and bone disorder; mortality; phosphate binders; phosphorus; sevelamer
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Sevelamer hydrochloride, a synthetic phosphate binder, licensed for treatment of calcium–phosphorus abnormalities in chronic kidney disease (CKD), is one of many high-cost pharmaceuticals (lanthanum carbonate, calcimimetics, vitamin D analogues) targeted specifically at patients with the CKD-Mineral and Bone Disorder (CKD-BMD) [1]. Phosphate binders, traditionally containing calcium or aluminium, improve metabolic abnormalities in CKD by reducing absorption of dietary phosphorus. Altered mineral metabolism occurs universally in people with stage 4 and 5 CKD [2], due to impaired excretion of phosphorus, reduced activation of vitamin D and a compensatory increase in parathyroid hormone (PTH) secretion [3]. These metabolic features of CKD are associated with deleterious clinical consequences, including muscle dysfunction [4], fracture [5], cardiovascular and soft tissue calcification [6] and death. Hyperphosphataemia and treatment-related hypercalcaemia have, in large-scaled cohort studies, been powerfully, consistently and independently associated with the excess all-cause
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