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Nephrol Dial Transplant (2003) 18: III90-III93
© 2003 European Renal Association-European Dialysis and Transplant Association

Original Article

Colestimide can be used as a phosphate binder to treat uraemia in end-stage renal disease patients

Toshiyuki Date1, Takashi Shigematsu2,, Yoshiteru Kawashita1, Nobuyoshi Satake1 and Kyoko Morita1

1 Jinaikai Date Clinic and 2 Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan

Colestimide is a potent therapeutic compound used widely for treatment of hypercholesterolaemia, and it was discovered coincidentally that it can be used to lower the serum phosphate concentration in cases of secondary hyperparathyroidism with refractory hyperphosphataemia. Colestimide is useful for treating hyperphosphataemia in end-stage renal disease (ESRD) patients undergoing haemodialysis. Twenty-eight patients who were being treated for hyperphosphataemia with 3.5±1.1 g/day calcium carbonate were enrolled in the study. Colestimide was added to their prescription for 4 weeks at a mean dosage of 2.3 g/day. The serum phosphate concentration decreased significantly from 6.1±1.1 mg/dl before treatment to 5.3±1.1 mg/dl at 4 weeks (P<0.0001). The calcium–phosphate product also decreased significantly from 59.6±11.3 mg/dl2 before treatment to 50.5±12.0 mg/dl2 (P<0.0001). The serum total cholesterol significantly (P<0.001) decreased at 1 week and remained constant until the end of treatment. Colestimide is a cationic polymer with chloride as the counterion. Its chemical structure resembles that of sevelamer hydrochloride, which is already being used clinically as a phosphate binder. This suggests that colestimide uses the same mechanism as sevelamer hydrochloride to treat hyperphosphataemia. The present results demonstrate that colestimide can function as a Ca-free, aluminium-free, non-absorbable, phosphate binder in ESRD patients. In addition, colestimide can reduce the serum phosphate concentration in combination with calcium carbonate.

Keywords: colestimide; end-stage renal disease; hyperphosphataemia; phosphate binder

Correspondence and offprint requests to: Takashi Shigematsu, MD, PhD, Assistant Professor, Division of Nephrology and Dialysis Unit, Department of Internal Medicine, Jikei University School of Medicine, Aoto-General Hospital, 6-41-2 Aoto, Katsushika-Ku, Tokyo 125-8506, Japan. Email: aotaki{at}jikei.ac.jp


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